diagnostic studies of gastrointestinal bleeding

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🌱 來自: gastrointestinal bleeding

diagnostic studies of gastrointestinal bleeding🚧 施工中

詳見➡️：JACR 2021;18:S139

UGIB:

• EGD w/in 24 h (NEJM 2020;382:1299).
• If severe bleed, ↑ dx/Rx yield if erythro 250 mg IV given 30 min prior to endoscopy to clear stomach contents.

詳見Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding.

LGIB:

• colonoscopy (identifies cause in >70%); early colo (w/in 24 h) unlikely to improve outcome vs. late (24-96 h) (Gastroenterology 2020;158:168).
• If hematochezia a/w orthostasis, concern for brisk UGIB → exclude UGIB w/ EGD first.
• Push enteroscopy, anoscopy, capsule endoscopy in combo w/ urgent colo results in dx >95% of cases (GI Endo 2015;81:889).

Imaging

• if too unstable for endo or recurrent bleeding, consider IR embolization or surgery
• tagged RBC scan: can identify general luminal location if bleeding rate ≥0.04 mL/min ⇒ 有夠準的
• CT angiography: faster to obtain than RBC scan, detects bleeding ≥0.3 mL/min
• arteriography: can localize exact vessel if bleeding rates ≥0.5 mL/min, allows for IR Rx
• Emergent exploratory laparotomy (last resort) if no localization and life-threatening bleed

Emergent exploratory laparotomy (last resort) if no localization and life-threatening bleed

Detail

上面提到的部分請OpenGPT講一次

• For upper gastrointestinal bleeding (UGIB), perform an Esophagogastroduodenoscopy (EGD) within 24 hours, as per the NEJM 2020 guidelines. If the bleeding is severe, administering erythromycin 250 mg intravenously 30 minutes prior to the endoscopy can increase the diagnostic and treatment yield.

• For lower gastrointestinal bleeding (LGIB), perform a colonoscopy, as it can identify the cause in more than 70% of cases. Early colonoscopy within 24 hours is unlikely to improve outcomes compared to a later colonoscopy within 24-96 hours, as per Gastro 2020. If there is hematochezia associated with orthostasis, there is a concern for brisk UGIB and exclude UGIB with EGD first. Combining push enteroscopy, anoscopy, and capsule endoscopy with an urgent colonoscopy results in a diagnosis in more than 95% of cases, as per GI Endo 2015.

• Imaging options can be used if a patient is too unstable for endoscopy or if there is recurrent bleeding. Interventional radiology (IR) embolization or surgery can be considered. A tagged red blood cell (RBC) scan can identify the general luminal location if the bleeding rate is ≥0.04 mL/min. A CT angiography is faster to obtain than an RBC scan and detects bleeding ≥0.3 mL/min. Arteriography can localize the exact vessel if the bleeding rate is ≥0.5 mL/min, and allows for IR treatment.

• An emergent exploratory laparotomy is a last resort option if no localization can be made and the bleeding is life-threatening.