Gastrointestinal hemorrhage: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
===Upper gastrointestinal tract bleeding=== | ===Upper gastrointestinal tract bleeding=== | ||
For patients | For patients with nonvariceal upper gastrointestinal tract bleeding, the Blatchford score is a [[clinical prediction rule]] for predicting patients that will require blood transfusion, endoscopic or surgical management for bleeding control.<ref name="pmid17870480">{{cite journal |author=Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT |title=Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding |journal=The American journal of emergency medicine |volume=25 |issue=7 |pages=774–9 |year=2007 |pmid=17870480 |doi=10.1016/j.ajem.2006.12.024 |issn=}}</ref> | ||
The score is high risk if the patient has any of the following: | The score is high risk if the patient has any of the following: | ||
Revision as of 06:00, 9 January 2008
Gastrointestinal hemorrhage (GI bleeding) is defined as "bleeding in any segment of the gastrointestinal tract from esophagus to rectum."[1]
Diagnosis
Upper gastrointestinal tract bleeding
Esophagogastroduodenoscopy (EGD) can help determine the cause of the bleeding. Intravenous erythromycin prior to endoscopy can help clear the stomach of blood to improve the exam.[2]
Lower gastrointestinal tract bleeding
Prognosis
Upper gastrointestinal tract bleeding
For patients with nonvariceal upper gastrointestinal tract bleeding, the Blatchford score is a clinical prediction rule for predicting patients that will require blood transfusion, endoscopic or surgical management for bleeding control.[3]
The score is high risk if the patient has any of the following:
- Blood urea nitrogen ≥18.2 (mg/dL)
- Hemoglobin level
- for men <13 (g/dL)
- for women <12 (g/dL)
- Systolic blood pressure <109(mm Hg)
- Pulse rate ≥100 beats/min
- Melena
- Syncope
- Hepatic disease
- Heart failure
In a study in which 69.5% of the patients were had blood transfusion, endoscopic or surgical management, the accuracy fo the score is:
- sensitivity = 99.6%
- specificity = 25.0%
which yielded:
- positive predictive value = 75.2%
- negative predictive value = 96.4%
Lower gastrointestinal tract bleeding
References
- ↑ National Library of Medicine. Gastrointestinal Hemorrhage. Retrieved on 2007-11-09.
- ↑ Winstead NS, Wilcox CM (2007). "Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost-effectiveness analysis". Aliment. Pharmacol. Ther. 26 (10): 1371–7. DOI:10.1111/j.1365-2036.2007.03516.x. PMID 17848180. Research Blogging.
- ↑ Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT (2007). "Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding". The American journal of emergency medicine 25 (7): 774–9. DOI:10.1016/j.ajem.2006.12.024. PMID 17870480. Research Blogging.