Upper gastrointestinal bleeding laboratory findings: Difference between revisions

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Latest revision as of 15:42, 14 December 2017

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

Overview

In patients with acute upper GI bleeding who are unstable rapid assessment and resuscitation should be initiated even before diagnostic evaluation. Once hemodynamic stability is achieved, a proper clinical history, physical examination, and initial laboratory findings are crucial not only in determining the likely sources of bleeding but also in directing the appropriate intervention. In acute GI bleeding, initial hematocrit level measured will not accurately reflect the amount of blood loss. Laboratory findings of chronic upper GI bleeding include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.

Initial Laboratory Studies

Common laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.^[1]^[2]
The hematocrit level is used to identify the degree of blood loss and suggests the acuity or chronicity of blood loss.^[3]^[4]
Serial complete blood count (CBC) tests are important for monitoring the presence of ongoing blood loss.
Initial CBC may not fully reflect the actual degree of acute blood loss.
On peripheral blood smear prepared with Wright-Giemsa stain, normal erythrocytes are smaller than the nucleus of a normal lymphocyte, and the central clear area should not be overly prominent.
- Iron-deficiency anemia is associated with chronic blood loss, in which erythrocytes are smaller (microcytic) and appear lighter (hypochromic) than normal cells.
Mild to moderate thrombocytopenia (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild thrombocytopenia.^[5]
Platelet count may rise in response to significant gastrointestinal bleeding and may fall with multiple blood transfusions.
Low ferritin level is the most specific test for iron-deficiency anemia. This finding together with a low iron and high TIBC levels are helpful in diagnosing iron-deficiency anemia, a common complication of ongoing or significant UGIB.^[1]
BUN level may be elevated out of proportion to any increase in the creatinine level in patients with UGIB, secondary to breakdown of blood proteins to urea by intestinal bacteria.^[6]
In patients with esophageal varices, acquired coagulopathies (Increased PT,PTT) are common due to cirrhosis.

Gastrointestinal Bleeding

Blood in Vomiting

Black tarry stools

Abdominal pain

Yes

No

Weight loss

Dysphagia

Yes

No

Yes

Mallory-Weiss syndrome
Boerhaave syndrome

Weight loss

Dyspepsia

Gastric cancer
Gastric ulcer

Yes

No

Yes

No

Esophageal carcinoma

Immune status

Duodenal ulcer

Varices

Immunocomprimised

Immunocompetent

Infectious esophagitis

Pill induced esophagitis

References

↑ ^1.0 ^1.1 Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2015). "Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding". World J. Gastroenterol. 21 (20): 6246–51. doi:10.3748/wjg.v21.i20.6246. PMC 4445101. PMID 26034359.
↑ Owensby S, Taylor K, Wilkins T (2015). "Diagnosis and management of upper gastrointestinal bleeding in children". J Am Board Fam Med. 28 (1): 134–45. doi:10.3122/jabfm.2015.01.140153. PMID 25567834.
↑ Raju GS, Gerson L, Das A, Lewis B (2007). "American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding". Gastroenterology. 133 (5): 1694–6. doi:10.1053/j.gastro.2007.06.008. PMID 17983811.
↑ Bull-Henry K, Al-Kawas FH (2013). "Evaluation of occult gastrointestinal bleeding". Am Fam Physician. 87 (6): 430–6. PMID 23547576.
↑ Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2016). "Low hemoglobin levels are associated with upper gastrointestinal bleeding". Biomed Rep. 5 (3): 349–352. doi:10.3892/br.2016.727. PMC 4998006. PMID 27588176.
↑ Wilkins T, Khan N, Nabh A, Schade RR (2012). "Diagnosis and management of upper gastrointestinal bleeding". Am Fam Physician. 85 (5): 469–76. PMID 22534226.

Template:WikiDoc Sources

[pmid26034359-1] 1.0 ^1.1 Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2015). "Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding". World J. Gastroenterol. 21 (20): 6246–51. doi:10.3748/wjg.v21.i20.6246. PMC 4445101. PMID 26034359.

[pmid25567834-2] Owensby S, Taylor K, Wilkins T (2015). "Diagnosis and management of upper gastrointestinal bleeding in children". J Am Board Fam Med. 28 (1): 134–45. doi:10.3122/jabfm.2015.01.140153. PMID 25567834.

[pmid17983811-3] Raju GS, Gerson L, Das A, Lewis B (2007). "American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding". Gastroenterology. 133 (5): 1694–6. doi:10.1053/j.gastro.2007.06.008. PMID 17983811.

[pmid23547576-4] Bull-Henry K, Al-Kawas FH (2013). "Evaluation of occult gastrointestinal bleeding". Am Fam Physician. 87 (6): 430–6. PMID 23547576.

[pmid27588176-5] Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2016). "Low hemoglobin levels are associated with upper gastrointestinal bleeding". Biomed Rep. 5 (3): 349–352. doi:10.3892/br.2016.727. PMC 4998006. PMID 27588176.

[pmid22534226-6] Wilkins T, Khan N, Nabh A, Schade RR (2012). "Diagnosis and management of upper gastrointestinal bleeding". Am Fam Physician. 85 (5): 469–76. PMID 22534226.

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[5]

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Upper gastrointestinal bleeding}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+{{CMG}} ; {{AE}} {{ADG}}
+==Overview==
+In patients with acute upper GI bleeding who are unstable rapid assessment and [[resuscitation]] should be initiated even before diagnostic evaluation. Once [[Hemodynamics|hemodynamic]] stability is achieved, a proper clinical history, [[physical examination]], and initial laboratory findings are crucial not only in determining the likely sources of [[bleeding]] but also in directing the appropriate [[Intervention (counseling)|intervention]]. In acute GI bleeding, initial [[hematocrit]] level measured will not accurately reflect the amount of blood loss. Laboratory findings of chronic upper GI bleeding include [[anemia]], [[coagulopathy]], and [[BUN-to-creatinine ratio|an elevated BUN-to-creatinine ratio.]]
-{{CMG}}
+==Initial Laboratory Studies==
+*Common laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]].<ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref><ref name="pmid25567834">{{cite journal |vauthors=Owensby S, Taylor K, Wilkins T |title=Diagnosis and management of upper gastrointestinal bleeding in children |journal=J Am Board Fam Med |volume=28 |issue=1 |pages=134–45 |year=2015 |pmid=25567834 |doi=10.3122/jabfm.2015.01.140153 |url=}}</ref>
-==Laboratory Findings==
+*The [[hematocrit]] level is used to identify the degree of [[blood loss]] and suggests the acuity or chronicity of [[blood loss]].<ref name="pmid17983811">{{cite journal |vauthors=Raju GS, Gerson L, Das A, Lewis B |title=American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding |journal=Gastroenterology |volume=133 |issue=5 |pages=1694–6 |year=2007 |pmid=17983811 |doi=10.1053/j.gastro.2007.06.008 |url=}}</ref><ref name="pmid23547576">{{cite journal |vauthors=Bull-Henry K, Al-Kawas FH |title=Evaluation of occult gastrointestinal bleeding |journal=Am Fam Physician |volume=87 |issue=6 |pages=430–6 |year=2013 |pmid=23547576 |doi= |url=}}</ref>
-* Laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]].
+*Serial complete blood count ([[CBC]]) tests are important for monitoring the presence of ongoing [[blood loss]].
+*Initial [[CBC]] may not fully reflect the actual degree of acute [[blood loss]].
-* Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult. Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult). Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate{{ref|5}}. Cuellar found the following results:
+*On [[peripheral blood smear]] prepared with [[Wright's stain|Wright-Giemsa stain]], normal [[erythrocytes]] are smaller than the nucleus of a [[Lymphocyte|normal lymphocyte]], and the central clear area should not be overly prominent.
-{| class="wikitable" style="text-align:center"
+**[[Iron-deficiency anemia]] is associated with chronic [[blood loss]], in which [[erythrocytes]] are smaller ([[microcytic]]) and appear lighter ([[hypochromic]]) than normal cells.
-|+ Determining whether blood is in the gastric aspirate{{ref|4}}
+*Mild to moderate [[thrombocytopenia]] (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild [[thrombocytopenia]].<ref name="pmid27588176">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Low hemoglobin levels are associated with upper gastrointestinal bleeding |journal=Biomed Rep |volume=5 |issue=3 |pages=349–352 |year=2016 |pmid=27588176 |pmc=4998006 |doi=10.3892/br.2016.727 |url=}}</ref>
-! Finding !! Sensitivity !! Specificity !! Positive predictive value<br>(prevalence of 39%)!! Negative predictive value<br>(prevalence of 39%)
+*[[Platelet count]] may rise in response to significant [[gastrointestinal bleeding]] and may fall with multiple [[blood transfusions]].
-|-
+*Low [[ferritin]] level is the most specific test for [[Iron deficiency anemia|iron-deficiency anemia]]. This finding together with a low [[iron]] and high [[Total iron-binding capacity|TIBC]] levels are helpful in diagnosing [[Iron deficiency anemia|iron-deficiency]] anemia, a common complication of ongoing or significant UGIB.<ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref>
-! Gastroccult
+*[[Blood urea nitrogen|BUN]] level may be elevated out of proportion to any increase in the [[creatinine]] level in patients with UGIB, secondary to breakdown of [[blood]] [[proteins]] to urea by intestinal [[bacteria]].<ref name="pmid22534226">{{cite journal |vauthors=Wilkins T, Khan N, Nabh A, Schade RR |title=Diagnosis and management of upper gastrointestinal bleeding |journal=Am Fam Physician |volume=85 |issue=5 |pages=469–76 |year=2012 |pmid=22534226 |doi= |url=}}</ref>
-| 95% || 82% || 77% || 96%
+*In patients with [[esophageal varices]], acquired [[coagulopathies]] (Increased [[Prothrombin time|PT]],[[Partial thromboplastin time|PTT]]) are common due to [[cirrhosis]].
-|-
+<small>
-! Physician assessment
+{{familytree/start |summary=Sample 1}}
-| 79% || 55% || 53% || 20%
+{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | A01=Gastrointestinal Bleeding}}
-|}
+{{familytree | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | | | | | | | |}}
-Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate{{ref|6}}. Holman found that by 120 seconds after the developer was applied, the Hemoccult test was positive on ''all'' control samples.
+{{familytree | | | | | | | | C01 | | | | | | | | C02 | | | | | | | | | | | | | |C01=Blood in Vomiting|C02=Black tarry stools|C03=Blood in stools}}
+{{familytree | | | | | | | | |!| | | | | | | | | |!| | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | |`|-|-|-| D01 |-|-|-|'| | | | | | | | | | | | | | | | D01=Abdominal pain |D02=Abdominal pain}}
+{{familytree | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | E01 | | | | | | | | | | | | | E02 | | | | | | | | | | | | | | | |E01='''Yes'''|E02='''No'''|}}
+{{familytree | | | | | | | |!| | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | F01 | | | | | | | | | | | | | F02 | | | | | | | | | | | | | | | | | |F01=Weight loss|F02=Dysphagia}}
+{{familytree | | | |,|-|-|-|^|-|-|-|-|-|.| | | | |,|-|-|-|^|-|-|-|-|.| | | | | | | | | |}}
+{{familytree | | | G01 | | | | | | | | G02 | | | G03 | | | | | | | G04 | | | | | | | | | |G01='''Yes'''|G02='''No'''|G03='''No'''|G04='''Yes'''}}
+{{familytree | | | |!| | | | | | | | | |!| | | | |!| | | | | | | | |!| | | | | | | | | |}}
+{{familytree | | | |!| | | | | | | | | |!| | | | H03 | | | | | | | H04 | | | | | | | | | |H03=Mallory-Weiss syndrome<br>Boerhaave syndrome|H04=Weight loss}}
+{{familytree | | | |!| | | | | | | | | H02 | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | |H02=Dyspepsia }}
+{{familytree | | | A01 | | | | |,|-|-|-|^|-|-|-|.| | | | | I03 | | | | | | I04 | | | | | |A01='''Gastric cancer'''<br>'''Gastric ulcer'''|I03=Yes|I04=No|}}
+{{familytree | | | | | | | | | I01 | | | | | | I02 | | | | |!| | | | | | | |!| | | | | | |I01=Yes|I02=No}}
+{{familytree | | | | | | | | | |!| | | | | | | |!| | | | | J03 | | | | | | J04 | | | | | |J03=Esophageal carcinoma|J04=Immune status}}
+{{familytree | | | | | | | | | J01 | | | | | | J02 | | | | | | | | |,|-|-|-|^|-|-|.| | | | |J01=Duodenal ulcer|J02=Varices}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | K01 | | | | | K02 | | |K01=Immunocomprimised|K02=Immunocompetent|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | |!| | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | | | L02 | | L01=Infectious esophagitis|L02=Pill induced esophagitis}}
+{{familytree/end}}
+</small>
 ==References==
@@ Line 30: / Line 52: @@
 [[Category:Emergency medicine]]
 [[Category:Needs overview]]
-[[Category:Mature chapter]]
 {{WikiDoc Help Menu}}
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Upper gastrointestinal bleeding laboratory findings: Difference between revisions

Latest revision as of 15:42, 14 December 2017

Overview

Initial Laboratory Studies

References

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