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Upper GI bleed - PowerPoint PPT Presentation


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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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Presentation Transcript
intro
intro
  • bleeding originating proximal to the ligament of Treitz
  • More common in men and elderly
  • More common than lower gi bleeds
pathophys
pathophys
  • Peptic ulcer disease
  • Erosive Gastritis and Esophagitis
  • Esophageal and Gastric Varices
  • Mallory-Weiss Syndrome
  • malignancy
diagnosis
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
treatment
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
reference
reference
  • Tintinalli, Ch. 78