Upper GI bleed vs bleeding espohageal varices

You can't tell from the amount of bleeding. Either diagnoses can cause a small or a large amount of bleeding. I was once admitted to a hospital with a diagnoses of upper G.I. bleed. I went for an immediate gastosomy. It turned out that I had a 4 cm tear in my espohagus, not a G.I. bleed.

Woody:balloons:

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.

In this day and age it is unusual to see gross GI bleed like we use to before ,dare I say Tagamet. I aged myself. We use to have to lavage,lavage ,lavage,,,,, Now an esophageal bleed,if a varice blows, u will know it. Sometimes it is hard to get close enough to the pt to treat. Blakemore tubes,,,lol,,,aging as I go,,,use to be used very freguently with these bleeds. Now with so much out there that diagnosis early and keeps varices under control, it is not as common. But you will see it.

GI bleed ,usually a pt will gag and vomit blood. Depending on the site it can range from bright red to dark maroon in color,clots also.(coffee ground) Lower GI, ususally tarry tarry stools or maroon,and sometimes if low enough,gross bleeding.

Esophageal varices,always red,unless a slow leak that they vomit up later. Can be like a fountain. With TIPS procedures and the such,it can be prevented or helped. If they blow, the goal is to stop the flow(blakemore or such) until they can get to interventional radiology for more invasive help.

Hope this helps some. Been awhile since I have worked with GI!

Sometimes you can't tell the difference, particularly with mild bleeds. Both have similiar symptons :hemetmesis, black and tarry stools, hypotension, pallor, tachycardia and shock, when symptons have progressed. However, with severe symptons of esophageal varices, the difference is marked. Instead of the patient actively vomiting blood, they will be literally hosing blood out of their mouths. If you think about the fact that EV are caused as a result of portal hypertension (secondary to liver disease, at least) with blood being 'backed up' the portal vein with a consequence of pressure build up, then you can imagine that when a large EV blows, it blows bright red blood and lots of it. As cmo421 said, you don't really see many of these nowadays but the patients clinical appearance will make it pretty clear that you maybe dealing with severe EV bleed as opposed to a upper GI bleed. There are never any certanities in medicine though.

Wow! Yuck. :)

So I read you have to insert an NG tube and lavage until the return is clear, or insert a tamponade - can you DO this while a patient is spewing forth blood like Old Faithful?

Wow! Yuck. :)

So I read you have to insert an NG tube and lavage until the return is clear, or insert a tamponade - can you DO this while a patient is spewing forth blood like Old Faithful?

An acute GI bleed doesn't spew forth blood like Old Faithful. Once you pass the ng tube, the patient pretty much stops vomiting. And it was quite simple to lavage with the ice NS(now I am really dating myself).

Woody:balloons:

Thanks, woody, but I meant with the bleeding espohageal varices... Can you insert the NG tube when they are bleeding heavily?

(sorry for the confusion)

An acute GI bleed doesn't spew forth blood like Old Faithful. Once you pass the ng tube, the patient pretty much stops vomiting. And it was quite simple to lavage with the ice NS(now I am really dating myself).

Woody:balloons:

lol...I was there too,,,,,forever until ur wrist was killing ya!

lol...I was there too,,,,,forever until ur wrist was killing ya!

It wasn't the lavaging til you dropped that got to me. It was cleaning up the dark, smelly, tarry poop:uhoh21:

Woody:balloons:

Most impressive bleed I ever saw was a woman with esophageal cancer. She had rung for assist to the bathroom; when I entered the room, she smiled and opened her mouth to say "hi"--- and a torrent of blood gushed forth. Then she fell back on the bed, dead. The tumor had eaten through a vessel and she exsanguinated within minutes. Her roommate witnessed this as well, and fainted, hanging off the edge of the bed.

It looked like something out of a horror movie...

Wow! Yuck. :)

So I read you have to insert an NG tube and lavage until the return is clear, or insert a tamponade - can you DO this while a patient is spewing forth blood like Old Faithful?

early in my career, a doctor and i were removing blakemore tubes from a pt.

the blood that spewed forth sent the md & me flailing back.

of course the pt died on the spot.

from that day on, i look at all my liver ca pts, with a dreaded anticipation.

thank goodness there are agents to give, when you expect a pt to bleed out.

leslie

Resuscitation of the patient with severe EV and managing the bleeding are priority here. Emergency management of the bleed would be insertion of a Sengstaken/Minnesota (at least thats what we call it in the UK, it may have a different name here), which looks like a large bore NG tube with deflated ballons along its length. One balloon is a gastric balloon and the other sits in the esopahgus and these are inflated to tamponade the bleed. It totally possible to pass these while the patient is impersonationg Old Faithful. However, its VERY messy and the person passing the tube needs to wear their protective gear. Especially, as EV's are often in highrisk patients. While this is all going on, hopefully someone has arranged a surgical admission for endoscope/banding/or whatever fancyshamcy techniques the hospital has and the patient has plenty of widebore access in which blood is being pored in...usually as fast as it is coming out. Remember that in the alcoholic liver disease patients, their clotting is often deranged and the patient may need Vit K,clotting factors or FFP as well. These patients also go off quite quickly and they may need their airway securing by way of intubation, so a full resus team should be present.