Upper GI bleed

Where can upper GI bleeds originate?

• gastric

• duodenal

• esophogeal

what are the causes of gastric/duodenal ulcers bleeding?

• PUD

• can be SRMD

what are the causes of esophageal bleeding?

• esophagitis

• Mallory-Weiss tear

• esophageal varices

What are the s/s of upper GI bleeds?

• Hematemesis - can be bright red or coffee ground

• Melena - black, tarry stools

• Hematochezia - bright red blood from rectum

• Hemoptysis - coughing up blood

• Occult blood

What are the s/s of acute UGI bleeds?

• bright red hematemesis

• lg amount of melena with clots

• Rapid pulse, drop in BP

• Hypovolemia

• shock

What are the s/s of subacute UGI bleeds?

• intermittent melena or coffee ground emesis

• HPN

• Weakness, dizziness

What are the s/s of chronic UGI bleeding?

• Intermittent appearance of blood

• Increased weakness

• Paleness

• SOB

• Occult blood

What are the early changes that occur with UGI bleeds?

• Rapid pulse (tachycardia)

• fatigue

• hematemesis

• melena, hematochezia

• cold extremities

What are the late changes that occur with UGI bleeds?

• Drop in BP

• S/s of shock - tachycardia, weak pulse, cool extremities, prolonged cap refill, apprehension

• clammy skin, pale skin

• shortness of breath

• reduced urine output

• decreased LOC

What is hemataemesis?

Blood in vomit

What is hematochezia?

Bright red blood in stool from upper GI source

What is melena?

Black, tarry stools

How is occult blood tested for in stool or vomit?

With a guaiac

What are the RF for UGI bleeds?

• SMRD

• PUD: H. pylori

• Esophagitis, mallory-weiss tear, esophageal varices

What is the nursing emergency treatment for GI bleed?

• Insertion of two lg bore IVs

  • hang saline for quick fluid replacement - use blood tubing

  • administer blood

• Administer O2

• Assess for perforation and peritonitis

• Administer PPI after surgery, and antacids when acute phase of bleed ends

what is the medical emergency treatment for GI bleed?

• Endoscopic therapy within 24hrs to determine treatment plan

  • can also treat with clips, bands, thermal ablation, injection

• Varices - need to be treated with ligation, sclerotherapy, balloon tamponade

• May need surgery if:

  • other interventions fail

  • 2000ml blood loss

  • shock

What is the treatment for UGI bleeds? Nursing and medical apart

• Avoid potential causes of GI bleeds:

  • NSAIDs

  • smoking

  • alcohol

• Modify meds, diet, lifestyle

How is a variceal bleed treated?

• avoid pressure (Severe coughing or sneezing)

• octreotide acetate

  • reduces blood flow to GI system

  • Inhibits stomach acid

  • decreases portal pressure

  • Decreases platelet aggregation

What is used to hold pressure on esophageal bleeds?

• Esophageal ballons

  • sengstaken blakemore tube

  • minnesota tube

• should not be inflated more than 24hrs

What meds are used to treat UGI bleeds?

• PPIs

• Antacids

• Octreotide (for varices)

• H2 receptor blockers

• Bismuth

What is an esophageal varices?

dilated, torturous veins d/t portal HTN

What are mallory-weiss tears?

• cracklike lacerations in the esophagus or stomach, usually in the gastroesophageal junction

what other s/s may esophageal varices have?

• Usually d/t portal HTN so may show signs of liver dmg aside from signs of bleeds:

  • Hepatic encephalopathy

  • Bruising

  • Bleeding

  • Pruritus

  • Jaundice

  • ascites

how is the location of the bleed assesed?

Endoscopy is gold standard, it also:

• Determines risk of re-bleeding

• Can provide endoscopic therapy

• Obtain specimen

• Monitor healing progress