Upper gastrointestinal bleeding is defined as hemorrhage from any source between the ______ and the _________.
pharynx –> ligament of Treitz
*upper MC than lower in pt presenting to emergency room
In a pt w upper GI bleed, the stool will look how? vs a lower GI bleed?
- Melena (black tarry stools)… st accompanied by hematemesis
- Hematochezia
Common Eti’s of Upper GI bleeding?
- PUD (50%)
- Esophagitis/varices/rupture (if varices, think cirrhosis)
- *Mallory-Weiss tears (NONTRANSMURAL TEAR)
- Boerhaave’s (tear in esophageal wall)
- Angiodysplasia
- CA
*Glasgow-Blatchford Score is used for what?
screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have urgent medical intervention such as a blood transfusion or endoscopic examination
*What markers does the Glasgow-Blatchford Score assess?
- Blood Urea
- Hgb (diff. for M/F)
- systolic BP
- others: pulse, melena, syncope, hepatic dz, cardiac failure
*What does the Rockall Scoring System assess?
to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding – in particular, the risk of dying from an acute UGI bleed
*What is the mnemonic used in the scoring system, Rockall?
ABCDE
- Age
- BP (shock?)
- Co-morbidity (ex. LR failure)
- Dx (ex. GI maligN)
- Evidence of bleeding
*AIMS-65 criteria is used for what?
less expensive screening tool for predicting mortality risk from an upper GI bleed
*AIMS-65 markers?
- Albumin less than 3.0 g/dL
- INR greater than 1.5 (clotting time)
- Mental status changes
- Systolic blood pressure
*Risk Factors for increased morbidity and mortality in pt’s w lower GI bleeds
- poor renal fx (creatinine > 150)
- > 60 yo
- abN, low BP
- persistent bleeing within first 24hrs of presention
