Beruflich Dokumente
Kultur Dokumente
• Hematemesis
• Melena
• Hematochezia
• Occult bleeding
Epidemiology Key Point: Mortality LGIB
< UGIB < Variceal bleeds
• Occult Bleeding:
Physical Exam Findings
• Vital signs
• Dry mucus membranes
• Stigmata of cirrhosis
• Fetid breath
• Weak pulses
• Cool skin
• Encephalopathy
Physical examination
• Vital signs, including orthostatics
• Skin: pallor, jaundice, ecchymoses, abnormal
blood vessels, hydration,
• Nasopharyngeal injection, tonsillar enlargement,
bleeding
• Abdomen: organomegaly, tenderness, ascites,
caput medusa
• Perineum: fissure, fistula, induration
• Rectum: gross blood, melena, tenderness
Further assessment
• Is it really blood?
• Hemoccult stool, gastroccult emesis
• Specific care
• Barrier agents (sucralfate)
• H2 receptor antagonists (cimetidine, ranitidine, etc.)
• Proton pump inhibitors (omeprazole, lansoprazole)
• Vasoconstrictors (somatostatin analogue, vasopressin)
• Volume replacement
▫ Normal saline
▫ Blood tranfusion
▫ Consider FFT/Cryo/FFP
Management – Suspected Varices
• Initial stabilization
• Splanchnic Vasoconstricters:
Octreotide/Vasopressin
• TIPS
• Minnesota tube / Blakemoore tube
• Antibiotic prophylaxis