Upper GI bleed vs bleeding espohageal varices - page 2

I am studying bleeding esohageal varices secondary to liver disease, and it makes me wonder how a nurse might be able to distinguish between an esophageal varices bleed and a "regular" upper GI... Read More

  1. by   core0
    Quote from natania
    I am studying bleeding esohageal varices secondary to liver disease, and it makes me wonder how a nurse might be able to distinguish between an esophageal varices bleed and a "regular" upper GI bleed? Is it related to the amount of blood involved?

    Thanks.
    You really can't tell the difference. Some people will tell you they can tell the difference between bright red arterial bleeding and venous bleeding of a varix but I can't.

    Varices only occur in the setting of portal hypertension. Usually the patient will have other signs such as ascites which would lead one to suspect liver disease.

    In these days where everyone is on Coumadin even small ulcers can produce impressive amounts of blood. Even in end stage liver disease ulcers are frequent and coagulopathy that is associated with this can lead to large volume bleeding.

    Generally hematemesis is bleeding from either the esophagus or the stomach. Generally if the stool is black it comes from an area above the transverse colon. If it is red or bright red it is from the transverse or descending colon. The rub here is that high volume bleeds with a fast transit time can be red (even bright red). Normal transit time is 2 hours or so for liquids but blood is very irritating for the intestine and transit time can be as fast as 20 minutes.

    As far as treatment, usually resuscitation and urgent endoscopy is the mainstay of US treatment. Usually medications such as IV proton pump inhibitor and Octreotide are used. The Sengstaken-Blakemore tube (usually called a Blakemore here) can be used but I saw it used only once in five years in a busy GI practice (it took a while to find it). If there is a gastric bleed that cannot be stopped by an EGD you can try a GDA ligation. Most variceal bleeds can be stopped with banding. Beta Blockers if the BP will allow this also help.

    Mostly its resuscitate and transfer to the ICU. It really doesn't matter what the etiology is the treatment is the same. You have to keep up with the volume and get ready to scope. In the age of IV Protonix about the only things that will get a GI physician out of bed at night is an upper GI bleed or a foreign body.

    David Carpenter, PA-C
  2. by   vashtee
    You guys are great! Thanks for all the advice.
  3. by   scattycarrot
    Quote from core0
    As far as treatment, usually resuscitation and urgent endoscopy is the mainstay of US treatment. Usually medications such as IV proton pump inhibitor and Octreotide are used. The Sengstaken-Blakemore tube (usually called a Blakemore here) can be used but I saw it used only once in five years in a busy GI practice (it took a while to find it). If there is a gastric bleed that cannot be stopped by an EGD you can try a GDA ligation. Most variceal bleeds can be stopped with banding. Beta Blockers if the BP will allow this also help.

    Further to this, the use of a Sengstaken tube is not a treatment but rather a way to try and manage the bleeding varices until you can get the patient to endoscopy. It can successfully control bleeding in about 90% of patients but roughly 55% do rebleed with it in situ so its obvioulsy just a tool to buy the patient time. Which is vital if you work in a department with no immediate access to endoscope. Interestingly, the last time the Sengstaken tube was used in my old place of work was on a woman in labour who had severe preeclampsia and acute fatty liver disease of pregnancy. She developed a severe acute GI bleed and they passed a Sengstaken to buy some time. It worked and she made it (eventually, after a few weeks in ITU). So, while this woman did not have a varices (at least,I don't think she did), sometimes you use what tools you have on hand!
    Last edit by scattycarrot on Oct 3, '07 : Reason: Clarification!

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