A night of only GI consults...

Not quite sure how I made it through 3 months without reviewing a GI bleed....

Last at least 4 patients were admitted with GI bleed.

We reviewed a gentleman,  unknown to powerchart, with hematemesis a significant etoh history and signs of portal hypertension on physical exam.

After stabilizing the patients with fluids +/- blood

Some of the specific managements:

1. IV PPi- Pantoprazole infusion: 80 mg IV bolus then 8 mg/hr

àWhat does it do? Suppresses gastric acid secretion by inhibiting the parietal cell H⁺/K⁺ ATP pump to↑ pH may improve platelet function

EVIDENCE: - decreases endoscopic stigmata, à NOT decrease mortality, or rebleeding or need for surgery

à most effective for PUD

--> more evidence post bleed (72 hours) (with a NNT of 7!! according to THIS article)

2. Octreotide: 50mcg then 50 mcg/h

--> WHat does it do? somatostatin analogue that reduces splanchnic blood flow and portal pressure.

 EVIDENCE:  modest reduction in the amount of transfused blood, a possible decrease in the rate of rebleeding, with no overall decrease in mortality

-->only evidence for Variceal bleed

3. Correct INR

4. Antibiotic therapy – Ceftriaxone or ciprofloxacin x 7 days

--> What does it do? proph for infection (SBP and bacteremia)

--> Start if patients have cirrhosis

EVIDENCE: Reduced rate of infection (SBP and bacteremia) and mortality

Here is a new JAMA article: Does this patient have an UGIB?