|
|
| (4 intermediate revisions by 4 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| Please help WikiDoc by adding content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.
| |
| {{Hematemesis}} | | {{Hematemesis}} |
| {{CMG}} {{JFS}} | | {{CMG}} {{AE}} |
| | |
| | {{PleaseHelp}} |
| | |
| ==Overview== | | ==Overview== |
| ==Primary Prevention== | | |
| Treatment of underlying disease is the best way to prevent hematemsis.
| | ==Primary prevention== |
| ===Prophylaxis Against Bleed From Variceal Hemorrhage and Ulceration ===
| |
| *Primary prophylaxis against variceal hemorrhage is indicated because of high rate of bleeding from esophageal varices and the high mortality associated with bleeding. Prophylactic [[propranolol]] or [[nadolol]] therapy is the only cost-effective therapy in this setting.
| |
| *Prophylaxis against [[stress]] ulceration maybe also indicated for ICU patients with any of the following characteristics:
| |
| #[[Coagulopathy]]
| |
| #Mechanical ventilation for more than 2 days
| |
| #History of GI ulceration or bleeding with the past year
| |
| #Two or more of the following risk factors — [[sepsis]], ICU admission lasting >1 week, occult GI bleeding lasting ≥6 days, and [[glucocorticoid]] therapy.
| |
| *Effective identification and antibiotic treatment of H.Pylori infections is also crutial in preventing complications including upper GI bleeding.
| |
| *In regards to the prevention of NSAID-related peptic ulcer disease and complicating upper GI bleed: patients are at the highest risk for NSAID-induced GI toxicity when they have any of these risk factors:
| |
| #A history of an ulcer or GI hemorrhage
| |
| #Age >60
| |
| #High dosage of a NSAID
| |
| #Concurrent use of glucocorticoids
| |
| #Concurrent use of anticoagulants
| |
| In these patients, the use of COX-2 selective inhibitor or a nonselective NSAID in combination with a PPI or misoprostol is indicated.
| |
| In addition, patients with a history of uncomplicated or complicated peptic ulcers should be tested for H. pylori prior to beginning a NSAID or low dose aspirin. If present, H. pylori should be treated with appropriate therapy, even if it is believed that the prior ulcer was due to NSAIDs.
| |
|
| |
|
| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
| [[Category:Needs content]] | | {{WS}} |
| | {{WH}} |
| | |
| | [[Category:Gastroenterology]] |
| | [[Category:Emergency medicine]] |