Upper gastrointestinal bleeding resident survival guide: Difference between revisions

Revision as of 21:29, 20 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Shown below is an algorithm summarizing the approach to [[disease name]].

Characterize the symptoms:

❑ Blood in vomiting
❑ Coffee ground emesis
❑ Black, tarry stools
❑ Frank blood in stools
❑ Maroon colored stool
❑ Abdominal pain
❑ Altered mental status
❑ Dizziness
❑ Syncope ❑ Palpitations
❑ Cold extremities

Physical examination

❑ Abdominal tenderness
❑ Involuntary guarding
❑ Heart rate (tachycardia suggests blood loss)
❑ Orthostatic blood pressure changes (hypotension suggests massive blood loss)
❑ Rectal exam to assess stool color
❑ Guaiac test

Order tests

❑ Blood type and cross-match
❑ CBC
❑ Platelet count
❑ Prothrombin time and INR
❑ Liver enzymes
❑ BUN
❑ Creatinine
❑ Electrolytes
❑ EKG

Initial assessment

❑ Ensure normal breathing and clear airway
❑ Monitor vital signs
❑ Cardiac monitoring
❑ Assess mental status
❑ Monitor urine output

Initial resuscitative measures

❑ Nil per oral
❑ 2 large bore IV lines
❑

References

Template:WikiDoc Sources

@@ Line 24: / Line 24: @@
 {{familytree/start |summary=PE diagnosis Algorithm.}}
 {{familytree | | | | | | | | | | | | A01 |A01=<div style="float: left; text-align: left; height: 20em; width: 20em; padding:1em;">'''Characterize the symptoms:'''<br>
----- ❑ Blood in [[vomiting]]<br> ❑ Coffee ground emesis<br>❑ Black, tarry stools<br>❑ Frank blood in stools<br>❑ Maroon colored stool<br>❑ [[Abdominal pain]]<br>❑ [[Altered mental status]]<br>❑ [[Dizziness]]<br> ❑ [[Palpitations]]<br>❑ Cold extremities<br></div>}}
+---- ❑ Blood in [[vomiting]]<br> ❑ Coffee ground emesis<br>❑ Black, tarry stools<br>❑ Frank blood in stools<br>❑ Maroon colored stool<br>❑ [[Abdominal pain]]<br>❑ [[Altered mental status]]<br>❑ [[Dizziness]]<br>❑ [[Syncope]] ❑ [[Palpitations]]<br>❑ Cold extremities<br></div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | B01=<div style="float: left; text-align: left; height: 16em; width: 20em; padding:1em;">'''Physical examination'''<br>
@@ Line 30: / Line 30: @@
 ❑ [[Abdominal tenderness]]<br>❑ Involuntary [[guarding]]<br> ❑ [[Heart rate]] ([[tachycardia]] suggests blood loss)<br>❑ Orthostatic blood pressure changes ([[hypotension]] suggests massive blood loss)<br>❑ [[Rectal exam]] to assess stool color<br>❑ [[Guaiac test]]</div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; height: 15em; width: 20em; padding:1em;">'''Order tests'''<br>
+{{familytree | | | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; height: 25em; width: 20em; padding:1em;">'''Order tests'''<br>
 ----
-❑ [[Blood type]] and [[cross-match]]<br>❑ [[Hemoglobin]] concentration<br>❑ [[Platelet count]]<br>❑ [[Prothrombin time]] and [[INR]]<br> ❑ [[Liver enzymes]]<br>❑ [[BUN]]<br>❑ [[Creatinine]]</div>}}
+❑ [[Blood type]] and [[cross-match]]<br>❑ [[CBC]]<br>❑ [[Platelet count]]<br>❑ [[Prothrombin time]] and [[INR]]<br> ❑ [[Liver enzymes]]<br>❑ [[BUN]]<br>❑ [[Creatinine]]<br>❑ [[Electrolytes]]<br>❑ [[EKG]]  </div>}}
 {{familytree | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | | | | D01 | | | | | | | | | | | | | | | | | | | |D01=<div style="float: left; text-align: left; height: 25em; width: 20em; padding:1em;">'''Initial assessment'''<br>
@@ Line 39: / Line 39: @@
 ----
 '''Initial resuscitative measures''' <br>
 ----❑ [[Nil per oral]]<br>❑ 2 large bore IV lines<br>❑
 </div> }}
 {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}