Advertisement

Diagnostic Testing for Patients with Gastrointestinal Hemorrhage

  • Ainsley Adams
  • Andrew C. MeltzerEmail author
Chapter

Abstract

Initial evaluation for GI bleeding requires a complete blood count (CBC), complete metabolic panel (CMP), coagulation tests, a type and screen, and a serum lactate level. For suspected or possible upper GI bleed cases, an urgent endoscopy should be performed within the first 24 h of admission. For unstable lower GI bleed patients, interventional radiography and/ or surgery should be consulted in the ED. Additional interventions like tagged red blood cell scans may be part of the emergency department workup in some cases. Video capsule endoscopy has shown potential to risk stratify patients in the ED.

Keywords

Lactate Endoscopy Video capsule endoscopy Colonoscopy Angiography Bleeding scan Tagged red blood cell Laparotomy 

References

  1. 1.
    Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101.CrossRefGoogle Scholar
  2. 2.
    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345–60.CrossRefGoogle Scholar
  3. 3.
    Bethea ED, Travis AC, Saltzman JR. Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;1(10):823–9.Google Scholar
  4. 4.
    Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459–74.CrossRefGoogle Scholar
  5. 5.
    Speir EJ, Ermentrout RM, Martin JG. Management of acute lower gastrointestinal bleeding. Tech Vasc Interv Radiol. 2017;20(4):258–62.CrossRefGoogle Scholar
  6. 6.
    Copeland A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up. Semin Intervent Radiol. 2014;31(3):235–42.CrossRefGoogle Scholar
  7. 7.
    Sos TA, Lee JG, Wixson D, Sniderman KW. Intermittent bleeding from minute to minute in acute massive gastrointestinal hemorrhage: arteriographic demonstration. AJR Am J Roentgenol. 1978;131(6):1015–7.CrossRefGoogle Scholar
  8. 8.
    Czymek R, Großmann A, Roblick U, et al. Surgical management of acute upper gastrointestinal bleeding:still a major challenge. Hepatogastroenterology [Internet]. 2012;59(115):768–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22469719Google Scholar
  9. 9.
    Zuckier LS. Acute gastrointestinal bleeding. Semin Nucl Med. 2003;33(4):297–311.CrossRefGoogle Scholar
  10. 10.
    Chandran S, Testro A, Urquhart P, et al. Risk stratification of upper GI bleeding with an esophageal capsule. Gastrointest Endosc. 2013;77(6):891–8.CrossRefGoogle Scholar
  11. 11.
    Sung JJY, Tang RSY, Ching JYL, Rainer TH, Lau JYW. Use of capsule endoscopy in the emergency department as a triage of patients with GI bleeding. Gastrointest Endosc. 2016;84(6):907–13.CrossRefGoogle Scholar
  12. 12.
    Meltzer AC, Ali MA, Kresiberg RB, et al. Video capsule endoscopy in the emergency department: a prospective study of acute upper gastrointestinal hemorrhage. Ann Emerg Med. 2013;61(4):438–443.e1.CrossRefGoogle Scholar
  13. 13.
    Jaramillo JL, de la Mata M, Mino G, Costan G, Gomez-Camacho F. Somatostatin versus Sengstaken balloon tamponade for primary haemostasia of bleeding esophageal varices: a randomized pilot study. J Hepatol. 1991;12(1):100–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineGeorge Washington University School of Medicine & Health SciencesWashington, DCUSA

Personalised recommendations