Upper Gastrointestinal Bleeding : Interprofessional Care

Interprofessional Care

• Endoscopic hemostasis therapy
  • First-line therapy of upper GI bleed
  • Goal: to coagulate or thrombose the bleeding vessel
  • Useful for gastritis, Mallory-Weiss tear, esophageal and gastric varices, bleeding peptic ulcers, and polyps
  • Several techniques are used including
    • Thermal (heat) probe
    • Multipolar and bipolar electrocoagulation probe
    • Argon plasma coagulation (APC)
    • Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser
    • Mechanical therapy with endoscopic clips or bands.
    • Multipolar electrocoagulation and thermal probe
• Surgical Therapy
  • Indicated when bleeding continues
    • Regardless of therapy provided
    • Site of bleeding identified
  • May be necessary when
    • Patient continues to bleed after rapid transfusion of up to 2000 mL whole blood
    • Remains in shock after 24 hours
  • Site of hemorrhage determines choice of operation
  • Surgeon must consider age of patient
    • Mortality rates increase considerably in older patients
• Drug Therapy
  • During acute phase, used to
    • Decreased Bleeding
    • Decreased HCl acid secretion
    • Neutralize HCl acid that is present
  • Empiric PPI therapy with high-dose IV bolus and subsequent infusion
  • Injection therapy with epinephrine during endoscopy for acute hemostasis
    • For bleeding due to ulceration
    • Produces tissue edema → pressure on bleeding source
  • Somatostatin or somatostatin analog octreotide
  • Used for upper GI bleeding
    • Reduces blood flow to GI organs and acid secretion
    • Given in IV boluses for 3–7 days after onset of bleeding