Gastrointestinal Bleeding: The Daily PANCE Blueprint

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Gastrointestinal Bleeding: The Daily PANCE Blueprint

A 58-year-old man presents to the emergency department with hematemesis. He reports vomiting bright red blood several times over the past hour. He has a history of alcohol abuse and cirrhosis. His vital signs are: blood pressure 90/60 mmHg, heart rate 115 bpm, respiratory rate 20 breaths/min, and oxygen saturation 98% on room air. On physical examination, he is pale and diaphoretic. His abdomen is soft and non-tender, with no palpable masses. Rectal examination reveals melena. After initiating appropriate resuscitation, which of the following is the most appropriate next step in the management of this patient?

A. Tagged red blood cell scan
B. Nasogastric tube lavage
C. Upper endoscopy (EGD)
D. CT angiography of the abdomen
E. Empiric proton pump inhibitor (PPI) therapy

Answer and topic summary

The answer is C. Upper endoscopy (EGD)

Upper endoscopy (EGD) is the most appropriate next step in the management of this patient with acute upper gastrointestinal bleeding (UGIB). EGD is the diagnostic and therapeutic modality of choice for UGIB. It allows for direct visualization of the bleeding source, and various therapeutic interventions can be performed during the procedure, such as epinephrine injection, thermal coagulation, or placement of clips or bands.

In this patient with a history of alcohol abuse and cirrhosis, variceal bleeding is a likely cause, and endoscopic band ligation would be the preferred treatment. Moreover, EGD should be performed within 24 hours of presentation in most patients with UGIB, and sooner (within 12 hours) in high-risk patients, such as those with hemodynamic instability or suspected variceal bleeding.

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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Gastric Disorders ⇒ Gastrointestinal bleeding

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