Bleeding GIT

Stable: suspected of Melena/hematochezia/hematemesis

Hx:

• Hx of Bleeding GIT (Endoscopy/Colonoscopy)
• EtOH
• Meds: Aspirin/Plavix/Warfarin/other anticoagulants/NSAID/TCM/Steroid
• Cocaine/Sympathomimetics: ulcer
• Pain/No pain doesn't correlate with endoscope
• Hx of liver disease/heart failure

PE

• Abdominal exam
• Cirrhosis
• Rectal: look for fissures/hemorrhoids/anoscope

Labs

• ECG if anemic
• FBC/PT/Urea/Type and screen
• NG aspirate and lavage in ED: low sensitivity for hematochezia/melena (without hematemesis); Academic Emergency Medicine Feb 2010
• No imaging

*80% will need rebleed, only 20% needs to catch, but this patients are those with liver disease, on steroids, etc

Screening/Scoring = Non variceal bleeding: All common sense

- Blatchford score, Modified Glasgow Blatchford score, Rockall, Lee

* assume it's upper always: more common, more commonly fatal, you can do something

* assume it's variceal (not ulcer)

* if unstable, NG tube always! varices are not contraindicated