Hematemesis medical therapy
|
Hematemesis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hematemesis medical therapy On the Web |
|
American Roentgen Ray Society Images of Hematemesis medical therapy |
|
Risk calculators and risk factors for Hematemesis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: John Fani Srour, M.D.
Overview
Medical Therapy
Treatment of hematesis depends on the underlying cause. The goal of medical therapy is to correct shock and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed.
- Stop diet, stabilize the patient with intravenous fluids, and transfuse to maintain a hemoglobin level of 8-10 g/dl, if necessary. Promptly correct any abnormalities in coagulation.
- Intravenous PPIs are the ideal pharmacologic therapy for patients with acute ulcer bleeding and rebleeding.
- Upper endoscopy can be used to treaat the active bleed.
General Management
The most common causes of upper GI bleeding include bleeding peptic ulcer disease, gastritis, and variceal bleed related to hepatic cirrhosis. This management section discusses general treatment of bleeding related to these common causes: In general, individuals who are at low risk for recurrent or life-threatening hemorrhage may be suitable for early hospital discharge or even outpatient care. All patients with hemodynamic instability or active bleeding should be admitted to an intensive care unit for resuscitation and close observation. Two large caliber peripheral catheters or a central venous line should be inserted for intravenous access. Gastroenterological consultation should be obtained. A surgical consultation can be obtained in high-risk patients. These patients should also receive packed red blood cell transfusions to maintain the hematocrit above 30 percent. In general, patients with upper GI bleeding (high and low risk patients) should be treated with an intravenous Protein pump inhibitor (PPI) at presentation until confirmation of the cause of bleeding, after which the need for specific therapy can be determined. Protein pump inhibitors are used because the most common causes of GI bleed are gastritis and peptic ulcer disease. Patients known to have cirrhosis who present with upper GI bleeding should receive antibiotics, preferably before endoscopy, as bacterial infections are present in up to 20 percent of these patients. Somatostatin may also reduce the risk of bleeding due to variceal and nonvariceal causes.