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Monday, 2 December 2013

Hemorrhaging: Upper gastrointestinal bleeding - Preventions and Treatments

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding (UGIB) is defined as hemorrhaging derived from a source proximal to the ligament of Treitz. It is life threatening and considered as medical emergency, which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment.
Prevention
1. Reduce stress
Stress-damage of upper gastro-intestinal tract (GIT) mucous membrane and gastro-intestinal hemorrhage (GIH)(17).

2. Cardiac surgery
GI bleeding events occurred approximately 10 days after cardiac surgery in patients with a complicated postoperative course. Improving the heart function is the best way to reduced risk of Upper gastrointestinal bleeding(18).

3. Drugs, alcohol and smoking
Chronic moderate alcohol consumption by itself does not seem to increase the liability to peptic ulceration. With highly concentrated alcoholic beverages, gastric bleeding from acute lesions may, however, be occasionally precipitated under certain circumstances, such as when unbuffered ASA is taken concomitantly. Smoking of cigarettes is associated, and perhaps causally related, with an increased incidence of gastric and duodenal ulcerations, impaired ulcer healing, and more frequent ulcer recurrences(19).

4. Avoid prolonged period intake of aspirin and medication which can induce Upper gastrointestinal bleeding (UGIB), such as Ibuprofen (Motrin, Advil)Naproxen (Anaprox, Naprosyn, Aleve)Ketoprofen (Orudis).

5. No extreme exercise
Gastrointestinal (GI) complaints are common among athletes with rates in the range of 30% to 70%. Both the intensity of sport and the type of sporting activity have been shown to be contributing factors in the development of GI symptoms. Three important factors have been postulated as contributing to the pathophysiology of GI complaints in athletes: mechanical forces, altered GI blood flow, and neuroendocrine changes. As a result of those factors, gastroesophageal reflux disease (GERD), nausea, vomiting, gastritis, peptic ulcers, GI bleeding, or exercise-related transient abdominal pain (ETAP) may develop(20).

6. Etc.


J.5. Treatments
Some researchers suggested that despite successful endoscopic therapy, rebleeding can occur in 10 to 20 percent of patients; a second attempt at endoscopic therapy is recommended in these patients. Arteriography with embolization or surgery may be needed if there is persistent and severe bleeding(16). Others indicated that Pre-endoscopic management (including use of scoring scales, nasogastric tube placement and blood pressure stabilization) is crucial for triage and optimal resuscitation of patients, and should include a multidisciplinary approach at an early stage. Unless the patient has specific comorbidities, transfusion should only be considered if their hemoglobin level is ≤70 g/l. Endoscopic therapy, the cornerstone of therapeutic management of high-risk lesions, should not be delayed for more than 24 h following admission. Several endoscopic techniques, mostly using clips or thermal methods, are available and new approaches are emerging. When endoscopy fails, surgery or arterial embolization should be considered. Although the efficacy of prokinetics and high-dose intravenous PPI prior to endoscopy is controversial, the use of an intravenous PPI following endoscopy is strongly recommended. Antiplatelet therapy should be suspended and resumed in 3-5 days. Finally, all patients should be tested for Helicobacter pylori by serology in the acute setting(21).
 
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Sources
(17) http://www.ncbi.nlm.nih.gov/pubmed/22834289
(18) http://www.ncbi.nlm.nih.gov/pubmed/22720275
(19) http://www.ncbi.nlm.nih.gov/pubmed/6378444
(20) http://www.ncbi.nlm.nih.gov/pubmed/22410703
(21) http://www.ncbi.nlm.nih.gov/pubmed/22230903
(1) http://www.ncbi.nlm.nih.gov/pubmed/22924257