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Upper Gastrointestinal Bleeding


It is essential to properly coordinate the diagnostic test early in the decision making process



Admission Criteria

  • History of dark stool (not bright red) in last 24-48 hours
  • No more than 2 episodes of bright red blood
  • GI or surgery consulted for evaluation (or endoscopy) within 24hr
  • Normal PT/INR, Hgb >10, normal Cr.
  • Rectal exam for guiac and orthostatics vitals done in the ED

Exclusion Criteria

  • Unstable VS (HR>100, SBP<100, RR>22) or fever (T>38)
  • Significant orthostatic changes (⇓ SBP>20); standing pulse >110
  • More than 2 episodes of bright red bleeding
  • Active bleeding = fresh voluminous hematemesis, multiple episodes of melena on day of arrival, or a significant amount of bright red bowel movement per rectum
  • Hgb <8.0, or a drop of Hct >10 in 4 hours (if repeated in the ED)
  • History of end stage liver disease, coagulopathy, portal hypertension, esophageal varices, or coumadin
  • EKG Changes
  • Social issues = inadequate home support

Potential Interventions

  • Serial Hct / Hgb Q6 hr
  • Guaiac stools / emesis prn.
  • IV Hydration, PPI or H2 blockers IV
  • Frequent VS – Q2 hours X3, then Q4hrs
  • NPO, I & O, clotting studies
  • GI Consult for possible endoscopy

Discharge Criteria

Home

    • Normal or stable serial exams
    • Stable VS
    • No deterioration in clinical condition
    • If endoscopy - no active bleeding, and follow-up arranged on PPI


Admit

    • Continual decrease in Hct/Hg
    • Recurrence of bleeding
    • Deterioration in clinical condition
    • Active bleeding by endoscopy


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