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2 results

  • 3.5.1 - Gastrointestinal Haemorrhage

  • from Section 3.5 - Acute Gastrointestinal Failure
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 205-207

  • Summary

    Key Learning Points

    1. 1. In suspected variceal bleeding, terlipressin and prophylactic antibiotics should be administered at presentation.

    2. 2. In upper gastrointestinal bleeding, a restrictive approach to blood transfusion reduces rebleeding rates and mortality.

    3. 3. Following a non-variceal upper gastrointestinal bleed in those taking aspirin for secondary prevention of vascular events, aspirin should be restarted when haemostasis is achieved.

    4. 4. Haematochezia is caused by an upper gastrointestinal bleed in approximately 10 per cent of presentations.

    5. 5. Early initiation of enteral feeding is effective in preventing bleeding from stress ulcer in critically unwell adults.

  • Chapter 44 - Eclampsia and pre-eclampsia

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 342-348

  • Summary

    The three common forms of presentation for acute gastrointestinal (GI) bleeds are: haematemesis, melaena, and haematochezia. This chapter discusses the complications associated with GI bleeding and management of GI bleeding. It lists the commonest causes of upper GI bleeding, and explains management of non-variceal upper GI bleeding and upper GI bleeding indications for surgery. Gastro-oesophageal varices are dilated submucosal veins which occur in approximately 40-60% of patients with cirrhosis. Control of active variceal bleeding has been shown to be achievable with sclerotherapy (80%) or band ligation (94%). The chapter discusses the incidence of upper GI perforation and lower GI perforation. Approximately 15% of patients with diverticulitis develop bowel perforation. The mortality rate is high (20-40%) as patients may suffer from sepsis and multiorgan failure. The chapter discusses initial management, specific management and post-operative complications of bowel perforation. Endoscopic treatment achieves haemostasis in the majority of patients with non-variceal bleeding.