GI Bleed (Kumar)
What is a massive GI bleed?
- Bleeding resulting in CVS collapse
- mortality up to 40%
- over 75% due to upper GI bleed (lower GI bleed mortality 2%)
Etiology
- Ulcers (Duodenal > Gastric)
- Gastritis
- Varices
- Oesophagitis
Team: Gastroenteritis, Surgeon, Interventional Radiologists
Pharmacotherapy
- PPI
- Reduces gastric acid secretion -> increase clot formation -> decrease clot lysis
- Evidence (post-endoscopy) – prevent rebleeds and decrease need for surgery
- Pre-endoscopy PPI
- Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. https://www.ncbi.nlm.nih.gov/pubmed/20614440
- Octreotide
- Decrease endoscopic treatment and transfusion BUT no effect on mortality
- Terlipressin
- Decrease splanchnic pressures
- Management by the intensivist of gastrointestinal bleeding in adults and children – https://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-2-46
- Antibiotics
- Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding – https://www.ncbi.nlm.nih.gov/pubmed/20824832
- Blood products
- Transfusion Strategies for Acute Upper Gastrointestinal Bleeding http://www.nejm.org/doi/full/10.1056/NEJMoa1211801#t=article
- Coagulopathy
- DDAVP – 0.3mcg/kg if on aspirin
- Rescue devices
- Sangstaken-Blackemore
- TIPPS
Acute pancreatitis (Marshall)
Pancreatitis is a chemical burn of the retroperitoneum
Incidence 10-80/100,000
Mortality 10-25%
Pathophysiology
- Fluid collection, ascites
- Pseudocyst
- Fat necrosis
Severity scores –
- Ranson https://en.wikipedia.org/wiki/Ranson_criteria
- Balthazar https://radiopaedia.org/articles/balthazar-score
- APACHE/SAPS
Resist antibiotics
No other intervention except PATIENCE!
Early surgery for pancreatitis do badly.