This document discusses the management of acute and chronic gastrointestinal bleeding in geriatric patients. It defines acute bleeding as sudden and life-threatening, while chronic bleeding occurs slowly over time until symptoms of blood loss appear. For acute bleeding, the goals are hemodynamic stability, stopping active bleeding, and preventing rebleeding. Initial steps involve resuscitation with IV fluids and blood transfusions as needed. The source of bleeding must then be identified through diagnostic tests like endoscopy before providing causal therapies specific to the underlying etiology.
This document discusses the management of acute and chronic gastrointestinal bleeding in geriatric patients. It defines acute bleeding as sudden and life-threatening, while chronic bleeding occurs slowly over time until symptoms of blood loss appear. For acute bleeding, the goals are hemodynamic stability, stopping active bleeding, and preventing rebleeding. Initial steps involve resuscitation with IV fluids and blood transfusions as needed. The source of bleeding must then be identified through diagnostic tests like endoscopy before providing causal therapies specific to the underlying etiology.
This document discusses the management of acute and chronic gastrointestinal bleeding in geriatric patients. It defines acute bleeding as sudden and life-threatening, while chronic bleeding occurs slowly over time until symptoms of blood loss appear. For acute bleeding, the goals are hemodynamic stability, stopping active bleeding, and preventing rebleeding. Initial steps involve resuscitation with IV fluids and blood transfusions as needed. The source of bleeding must then be identified through diagnostic tests like endoscopy before providing causal therapies specific to the underlying etiology.
condition that required earlier and intensive care which are suddenly life threatening. Chronic gastrointestinal bleeding occurs in slow and intermittent time until the symptoms from blood loss or anemia will result
Physical examination Search for the cause of bleeding according anamnesis or others etiology 9/5/2014 8 Nasogastric tube for diagnosis (do not insert permanently due to worsen the disorders) Rectal examination UGI / LGI Endoscopy
Laboratory Examination: routine blood/ urine BUN / S creatinin LFT PT/aPTT
9/5/2014 9 The Aim : - hemodynamic stability - stop active bleeding - prevent rebleeding
Patients Resuscitation : intravenous fluids, correct the airways measurement the grading of blood loss (pulse and systolic blood pressure) Pulse 100 beats/minute colloid/NaCl 0.9% infusion
9/5/2014 10 POSTURAL SIGNS
Principle : Blood loss loss of intravascular volume - a drop in Cardiac output & blood pressure. - rapid pulse
To estimate the intravascular volume status : Patient lay down measurement of pulse and blood pressure then patient sit down with measurement repeated If an increase in the pulse of 10 beats per minute or a drop in systolic blood pressure of 10 mm Hg about 20% of blood loss prediction
9/5/2014 11 In Shock patient, systolic blood pressure 90 mmHg & pulse > 100 beats/mnt, cold sweat, pallor, cold extremity about 40% of blood loss prediction
Obtain blood type and cross-match for transfusion, level of hematocrite (hemoglobin level not fit to quantity of acute bleeding because of require 8 hours minimal for hemodilusion to occur
12 Shock patient Bleeding continously Symptoms of angina pectoris Hematocrite < 20% High risk patients : older patients, coexisting cardiac illnesses, hepatic cirrhosis transfusion of packed red cells until Ht > 30% Young healthy patients transfusion of whole blood until Ht > 20% Use transfusion of fresh frozen plasma for coagulopathy and transfusion of trombocyte for low of trombocyte
9/5/2014 13 Initiation for immediate transfusion : Hemodynamic state is a good indicator for blood transfusion better than Hb. Transfusion to be given until restoring hemodynamic stability or Ht 25 30%
Causal Therapy Dependent of Etiology Endoscopic treatment 9/5/2014 14 15 Fig. 2 Investigation algorithm for acute GI bleed. Confirm acute upper/lower GI bleed Assess severity Resuscitate Low risk Severe/high risk Ongoing bleeding Endoscopy on next available list Urgent endoscopy Endoscopic therapy + Monitor closely Surgery Monitor closely High-risk lesion Low-risk lesion Endoscopic therapy Early discharge Period of observation before discharge