Template:UGIB evaluation: Difference between revisions
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===Workup=== | ===Workup=== | ||
*2 large bore IVs | *2 large bore IVs (or [[sheath introducer]]) | ||
*Type and cross | *Type and cross | ||
*CBC & serial hemoglobin | *CBC & serial hemoglobin | ||
| Line 24: | Line 24: | ||
**Provides useful information in only minority of patients without hematemesis | **Provides useful information in only minority of patients without hematemesis | ||
**[[Erythromycin]] 200mg IV can provide equal endoscopy conditions as lavage<ref>Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74(5):971-980.</ref> | **[[Erythromycin]] 200mg IV can provide equal endoscopy conditions as lavage<ref>Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74(5):971-980.</ref> | ||
===Diagnosis=== | |||
*Endoscopy frequently required for definitive diagnosis of underlying etiology | |||
Latest revision as of 22:17, 7 February 2024
Workup
- 2 large bore IVs (or sheath introducer)
- Type and cross
- CBC & serial hemoglobin
- Chemistry
- BUN/creatinine >30 suggests UGI if no history of renal failure (increased absorption/digestion of hb)
- Coags
- LFTs
- Fibrinogen
- Guiac
- More useful for diagnosing chronic occult bleeding (it could be positive for up to 2 weeks after an acute bleed)
- False-positive: vitamin C, red meat, methylene blue, bromide preparations, turnips, horseradish
- ECG (if >40 yo or if suspicious for silent MI, especially from demand ischemia)
- CXR (if suspect perforation)
NG Lavage Controversy
- Pros[1]
- Positive aspirate proves strong evidence for an upper GI source of bleeding
- Can assess presence of ongoing active bleeding
- Can prepare patient for endoscopy
- Cons[1]
- Uncomfortable
- Negative aspirate does not conclusively exclude upper GI source
- Provides useful information in only minority of patients without hematemesis
- Erythromycin 200mg IV can provide equal endoscopy conditions as lavage[2]
Diagnosis
- Endoscopy frequently required for definitive diagnosis of underlying etiology