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Upper GI bleed

Upper GI bleed. intro. bleeding originating proximal to the ligament of Treitz More common in men and elderly More common than lower gi bleeds. pathophys. Peptic ulcer disease Erosive Gastritis and Esophagitis Esophageal and Gastric Varices Mallory-Weiss Syndrome malignancy.

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Upper GI bleed

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  1. Upper GI bleed

  2. intro • bleeding originating proximal to the ligament of Treitz • More common in men and elderly • More common than lower gi bleeds

  3. pathophys • Peptic ulcer disease • Erosive Gastritis and Esophagitis • Esophageal and Gastric Varices • Mallory-Weiss Syndrome • malignancy

  4. Diagnosis • History • Red blood in stool is upper GI bleed 14% of time • Physical Exam • Imaging • endoscopy • Labs • Type and cross • H and H • BUN/Cr > 30 suggests UGI bleed

  5. Treatment • ACBs • In general, blood indicated if no improvement after 2 L of crystalloids • Endoscopy • Protonix, 80 mg bolus, then 8 mg/hr • Octretide, 25-50 mcb bolus, then 25-50 mcg/hr

  6. reference • Tintinalli, Ch. 78

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