위장관출혈에 대한 저널 정리

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위장관출혈에 대한 저널 정리입니다.

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Introduction
Initial management
Patient Triage and Risk Stratification
Patients at Low Risk
Patients at high risk
Medical Therapy
Surgery & Interventional radiology
Question

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Introduction
In the USA, 160 hospital admissions per 100,000 population
≥ 400,000 per year
90~95%, nonvariceal causes, with gastroduodenal peptic ulcer
Peptic ulcer bleeding predominantly among the elderly
68% of patients > 60 years
27% of patients > 80 years
Mortality associated with peptic ulcer bleeding 5~10%
Initial management
M/C presenting sign -> Hematemesis and melena
Hemodynamic assessment (pulse, BP, orthostatic changes)
Acute upper GI bleeding and a substantial loss of intravascular volume
① resting tachycardia (pulse,100 beats/min)
② hypotension (SBP, <100 mm Hg)
③ postural changes (increase in the pulse of 20 beats/min
drop in SBP 20 mmHg on standing)
④ others) Mucous membranes, neck veins, and urine output
Initial management
First priority in treatment
① correcting fluid losses and restoring hemodynamic stability
② volume resuscitation
③ maintain adequate oxygen-carrying capacity
④ supplemental oxygen
* transfusion of plasma expanders with packed RBC
1) tachycardia
2) hypotension
3) Hb < 10 g/dL
⑤ correction of coagulopathy
Insertion of a NG tube may be helpful in the initial assessment
① red blood in the NG aspirate -> adverse prognostic sign
② identifying patients who require urgent endoscopic evaluation
Patient Triage and Risk Stratification
Patient Triage and Risk Stratification
Patient Triage and Risk Stratification
Patient Triage and Risk Stratification
Patients at high risk

참고 자료

N Engl J Med 359:928-937, August 28,2008
Gut 51: iv1 - iv6 Oct 2002