09-7
Chapter One
Approach to the patient with gross
gastrointestinal bleeding
Grace H. Elta, Mimi Takami
Gastrointestinal (GI) bleeding is a common clinical problem
that requires more than 300 000 hospitalizations annually
in the United States. Most bleeding episodes resolve spontaneously;
however, patients with severe and persistent bleeding
have high mortality rates. Evaluation of a patient with
bleeding begins with assessment of the urgency of the situation.
Resuscitation with intravenous fluids and blood products
is the first consideration. Once the patient's condition
is stable, a brief history and physical examination will help
determine the location of the bleeding. For probable or
known upper GI bleeding, a nasogastric tube is placed to
help determine the location of bleeding and to monitor
the rapidity of the bleeding. The algorithm in Figure 1.1 is
a general guideline for evaluation of nonvariceal upper GI
bleeding. There is an important exception to this algorithm;
endoscopy may be used urgently in all patients with upper
GI bleeding regardless if their bleeding has stopped spontaneously,
allowing triage o ... read full excerpt from Atlas of Gastroenterology ebook
