UPPER GI BLEED. Presentation designed by Wendy Gerstein, MD Department of Medicine NMVAHCS. Objectives. Recognize bleeding and level of severity. Have a differential diagnosis for the bleeding. Know how to stabilize the patient and stop the bleeding. Decrease risk of future bleeding.
Presentation designed by Wendy Gerstein, MD
Department of Medicine
Meds: methocarbamol 750 mg po tid, etodolac 400mg po bid**. No known drug allergies
In ER – nasogastric tube placed – removed 400 cc dark red liquid, lavaged to clear with 500cc of normal saline.
Where would you place him?
He was admited to MICU, 2 peripheral IV’s secured, started on IV octreotide, IV pepcid, IVF’s, vitals and hct monitored.
Patient stared on IV protonix, switched to oral omeprazole 40 mg po bid next day. Hematocrit reached nadir of 29.5 (required no transfusions). Discharged with substance abuse follow up, and recommendations for repeat EGD in 3 months time.
Proton Pump Inhibitors: inhibit production of H+/K+ adenosine triphosphate (final step in acid production).
Break point: continue for specific discussions on PUD, H. pylori, varices, and Mallory-Weiss tears, if time permits.
- post-prandial pain 2-5 hours after eating.
- relief with antiacids.
- bloating, nausea, early satiety.
Complications (other than bleeding) include obstruction, penetration (pancreas, duodenum) or perforation.
One study from Hong Kong in 2002 showed that the prevalence of ulcers was significantly decreased in patients who had H. pylori eradicated (prior to starting NSAID’s).
Treatment is with various combinations of a PPI and two antibiotics for 2 weeks.