Gastrointestinal bleeding: Difference between revisions

Latest revision as of 09:29, 22 March 2026

Gastrointestinal Bleeding Pages

Calculators

Glasgow-Blatchford Bleeding Score

Glasgow-Blatchford Bleeding Score (GBS)
Criteria	Select
BUN (mg/dL)	1 <18.2 (0) 18.2–22.3 (+2) 22.4–27.9 (+3) 28–69.9 (+4) ≥70 (+6)
Hemoglobin — Male (g/dL)	1 ≥13 (0) 12–12.9 (+1) 10–11.9 (+3) <10 (+6)
Hemoglobin — Female (g/dL)	1 ≥12 (0) 10–11.9 (+1) <10 (+6)
Systolic BP (mmHg)	1 ≥110 (0) 100–109 (+1) 90–99 (+2) <90 (+3)
Heart rate ≥100 (+1)	1 No Yes
Melena (+1)	1 No Yes
Syncope (+2)	1 No Yes
Hepatic disease (+2)	1 No Yes
Cardiac failure (+2)	1 No Yes
GBS Score	/ 23

Interpretation
0	Very low risk — Can be considered for outpatient management. Virtually 0% chance of needing intervention.
1‒11	Moderate risk — Consider inpatient management and endoscopy.
≥12	High risk — Urgent intervention likely needed.

References
Blatchford O, et al. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-1321. PMID 11073021. Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373(9657):42-47. PMID 19091393.

References

Authors:

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-==Workup==
+<languages/>
+<translate>
+</translate>
-ER
+{{GI bleeding pages}}
+<translate>
-) 2 large bore IV
-) Icon
-) CBC & serial Hb
-) Chem 7 (BUN/Cr >35 suggests UGI if no hx of RF)
-) T&S/T&C
-) Coags (if INR > 1.5 transfuse FFP)
-) ?Guiac
-) LFTs/lipase
-) *CXR if sx perf (diff TTP abd)
-) *ECG (if >50 yo or if suspicious for silent MI)
-) NG lavage (controversial)
-) IVF/blood
-) IV PPI (Protonix 40-80mg x 1, then 8mg/hr)
-) Octreotide (suspected varices: 50mcg bolus, then 25mcg/hr)
-) Ceftriaxone (if e/o ascites; decreases mortality)
-) *Consider vasopressin/sengstaken-blakemore tube if no access to endoscopy
-*If aortic graft --> immed surg consult
-Consider
--Proctoscopy (22cm from anal verge)
--Sigmoidoscopy (60cm from anal verge)
--Angiography (requries arterial bledding >0.5cc/min)
--CT angio
-== ==
-==DDX==
-===Adult===
--UGIB-
-PUD (Gastric 21%, Duodenal 24%)
-Gastritis 23%
-Esophagitis/Duodenitis 6%
-Varicies
-Mallory-Weiss < 15%
-Boerhaave's
-Dieulafoy lesion
-Angiodysplasia
-Hemobilia
-Aortoenteric fistula
--LGIB-
-Upper GI bleed
-Diverticulosis (painless, voluminous)
-Infectious (virus, bacteria, parasites, C. dif)
-Ischemic Colitis 3-12% (acute onset; 90% > 70yo)
-IBD (fistula-in-ano)
-Mesenteric Vascular Insufficiency (abd pain out of proportion to PE)
-Angiodysplasia
-Cancer/polyps
-Rectal dz
-Hemorrhoids
-     External (below pectinate); Internal (above)
-Ulcer (HIV, syphilis, STDs)
-Fissures (painful defecation)
-Abscess, prolapse, proctitis, impaction
-===Peds===
--UGIB-
-Esophagitis
-Gastritis
-Ulcer
-Esophageal varices
-Mallory-Weiss
--LGIB-
-Anal fissure
-Infectious colitis
-IBDPolyps
-Intussusception
-==Disposition==
-Blatchford score
-Rockall score
--Home (very low risk)-
-No comorbid dz
-Normal vitals
-Norma/trace pos guiac
-Normal/near-normal Hb
-Home support
-F/U within 24hrs
--Ward/Stable (low risk)-
-Age <60
-Initial SBP >100
-Normal vitals x 1hr
-No transfusion req
-No major comorbid
-No liver dz
--ICU-
-Normal or dec Hct
-Blood in NG doesn't clear
-SBP<100, HR>100
-Gauaic +/- stool
-==False Positive Guaiac==
-Red fruits and meats
-(Bananas, turnips, broccoli)
-Methylene blue
-Chlorophyll
-Iodide
-Cupric sulfate
-Bromide
-Iron (causes GI bleed by irritation)
-==Source ==
-/12/06 DONALDSON (adapted from Rosen), Kaji
+== Calculators ==
+{{Glasgow_Blatchford_Calculator}}
+==References==
+<references/>
 [[Category:GI]]
+[[Category:Symptoms]]
+</translate>