Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

5Oct/11Off

Upper GI Bleeds

Paul Musey, MD

  • Emergent use of PPIs do not reduce re-bleeding, need for transfusions, need for surgery or mortality. When western population patients are sub-analyzed out of the 2006 Cochran review there appears that there may actually be associated harm (increased mortality). 2 of the 3 western population studies were stopped early secondary to a 5% increased mortality when compared to controls.

http://smartem.org/smartem.org/Blog/Entries/2011/7/15_Upper_GI_Bleed__PPIs.html

http://smartem.org/smartem.org/Blog/Entries/2011/7/15_Upper_GI_Bleed__PPIs_files/PPI%20Revman%20meta-analysis%20Figures.pdf

  • Antibiotics (Cipro or Ceftriaxone) are an essential adjunct to the treatment of UGIB patients with portal hypertension. They have been shown to reduce infections (SBP etc),  rebleeding, blood transfusions, and mortality.
  • AE Fistulas: Can present as a GI bleed many years after AAA repair or aortoiliac/aortofemoral bypass. They can present with Chiari's triad: Mid thoracic pain, Herald arterial bleed, and Exsanguination after symptom free interval.

 

 

Comments (1) Trackbacks (0)
  1. What’s up, the whole thing is going perfectly heree and
    ofcourse every one is sharing information, that’s trully fine, keep up writing.


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