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

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