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algorithm for management of GI bleed
Management:
1) nasogastric aspirate is the initial diagnostic procedure
2) if nasogastric aspirate is positive for blood, upper GI endoscopy
3) if nasogastric aspirate is negative & the aspirate contains bile, perform colonoscopy unless risk factors for upper GI bleeding are present
4) if profuse GI bleeding precludes colonoscopy, perform angiography of the mesenteric vessels
5) if bleeding is not perfuse, perform Tc-99m Tc-99m labeled erythrocyte scan to determine need for angiography
6) for slow, obscure bleeding, repeat upper endoscopy for:
a) linear erosions of gastric hiatal hernia mucosa (Cameron erosions)
b) gastric antral vascular ectasias (Dieulafoy lesions) before evaluating the small intestine
7) for suspected small intestine bleeding, perform push enteroscopy or capsule endoscopy
Related
gastrointestinal hemorrhage
General
algorithm
References
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006