Page 3 - Gastrointestinal Bleeding (Xuất huyết tiêu hóa)

CHAPTER 20 Gastrointestinal Bleeding 277

Severe UGI bleeding
20

History and physical examination

Hematochezia,
Admission to syncope, shock, Type and crossmatch, CBC, chemistry panel, Stable vital signs and
ICU comorbidities, liver biochemical tests, coagulation tests. laboratory values; no
onset of bleeding in Transfusions as indicated active bleeding
hospital
Hemodynamic resuscitation (ongoing) Admission to standard
hospital bed

Gastroenterology consultation

Octreotide (bolus and High-dose PPI therapy
infusion) if chronic liver if peptic ulcer suspected
disease suspected or
confirmed
Hypotension, vomiting red Stable vital signs with melena or
blood, or hematochezia; coffee-ground emesis
place NG tube

Urgent EGD (after hemodynamic EGD (or push
stabilization and IV prokinetic agent) enteroscopy) within 24 hours of
within 6-12 hours of presentation presentation

Specific endoscopic treatment (see Fig. 20.2)
Fig. 20.1 Algorithm for the initial management of severe UGI bleeding. Some steps may take place simultane-
ously or in varying order and in the emergency department, depending on the clinical situation.

TABLE 20.1 Suspected Source of GI Bleeding as Suggested by a Patient’s History
Suspected Source of Bleeding History
Nasopharynx History of nasopharyngeal radiation
Prior nasopharyngeal malignancy
Recurrent epistaxis
Lungs Hemoptysis
Esophageal ulceration GERD
Heartburn
Heavy alcohol use
Odynophagia
Pill ingestion
Traumatic NG tube placement
Esophageal cancer Dysphagia
History of Barrett esophagus
Weight loss
Mallory-Weiss tear Alcohol binge
Vomiting
Cameron lesions Large hiatal hernia
Esophageal or gastric varices or Chronic liver disease
portal hypertensive gastropathy Cirrhosis
Morbid obesity
Gastric angiodysplasia Aortic stenosis
Chronic kidney disease
Systemic sclerosis