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| ==Workup==
| | #[[Upper GI Bleeding]] |
| ===ER===
| | #[[Lower GI Bleeding]] |
| # 2 large bore IV
| | #[[GI Bleeding (Peds)]] |
| # Icon
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| # CBC & serial Hb
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| # Chem 7 (BUN/Cr >35 suggests UGI if no hx of RF)
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| # T&S/T&C
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| # Coags (if INR > 1.5 transfuse FFP)
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| # ?Guiac
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| # LFTs/lipase
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| # ?CXR if sx perf (diff TTP abd)
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| # ?ECG (if >50 yo or if suspicious for silent MI)
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| # NG lavage (controversial)
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| # IVF/blood
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| # IV PPI (Protonix 40-80mg x 1, then 8mg/hr)
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| # Octreotide (suspected varices: 50mcg bolus, then 25mcg/hr)
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| # Ceftriaxone (if e/o ascites; decreases mortality)
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| # ?Consider vasopressin/sengstaken-blakemore tube if no access to endoscopy
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| If aortic graft --> immed surg consult
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| ===Consider===
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| #Proctoscopy (22cm from anal verge)
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| #Sigmoidoscopy (60cm from anal verge)
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| #Angiography (requries arterial bledding >0.5cc/min)
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| #CT angio
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| ==DDX==
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| ===Adult===
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| #UGIB
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| ##PUD (Gastric 21%, Duodenal 24%)
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| ##Gastritis 23%
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| ##Esophagitis/Duodenitis 6%
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| ##Varicies
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| ##Mallory-Weiss <15%
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| ##Boerhaave's
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| ##Dieulafoy lesion
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| ##Angiodysplasia
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| ##Hemobilia
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| ##Aortoenteric fistula
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| #LGIB
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| #Upper GI bleed | |
| #Diverticulosis (painless, voluminous) | |
| #Infectious (virus, bacteria, parasites, C. dif) | |
| #Ischemic Colitis 3-12% (acute onset; 90% > 70yo)
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| #IBD (fistula-in-ano)
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| #Mesenteric Vascular Insufficiency (abd pain out of proportion to PE)
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| #Angiodysplasia
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| #Cancer/polyps
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| #Rectal dz
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| #Hemorrhoids
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| ##External (below pectinate); Internal (above)
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| #Ulcer (HIV, syphilis, STDs)
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| #Fissures (painful defecation)
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| #Abscess, prolapse, proctitis, impaction
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| ===Peds===
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| #UGIB
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| ##Esophagitis
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| ##Gastritis
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| ##Ulcer
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| ##Esophageal varices
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| ##Mallory-Weiss
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| #LGIB
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| ##Anal fissure
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| ##Infectious colitis
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| ##IBD
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| ##Polyps
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| ##Intussusception
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| ==Disposition==
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| Blatchford score
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| Rockall score
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| ===Home (very low risk)===
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| #No comorbid dz
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| #Normal vitals
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| #Norma/trace pos guiac
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| #Normal/near-normal Hb
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| #Home support
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| #F/U within 24hrs
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| ===Ward/Stable (low risk)===
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| #Age <60
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| #Initial SBP >100
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| #Normal vitals x 1hr
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| #No transfusion req
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| #No major comorbid
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| #No liver dz
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| ===ICU===
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| #Normal or dec Hct
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| #Blood in NG doesn't clear
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| #SBP<100, HR>100
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| #Gauaic +/- stool
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| ==False Positive Guaiac==
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| #Red fruits and meats
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| ##(Bananas, turnips, broccoli)
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| #Methylene blue
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| #Chlorophyll
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| #Iodide
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| #Cupric sulfate
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| #Bromide
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| #Iron (causes GI bleed by irritation)
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| ==Source ==
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| 3/12/06 DONALDSON (adapted from Rosen), Kaji
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| [[Category:GI]] | | [[Category:GI]] |
| | [[Category:Symptoms]] |
