2025 Multiprofessional Critical Care Review: Adult Online-Gastrointestinal Bleeding

Video Transcription

Video Summary

This lecture discusses the management of gastrointestinal (GI) bleeding, focusing on both upper and lower GI bleeds. In a 75-year-old patient presenting with upper GI bleeding, initial management includes large-bore peripheral IV access and crystalloid fluid resuscitation. Upper GI bleed is often indicated by melena, coffee-ground emesis, or a high BUN-to-creatinine ratio. Peptic ulcer disease remains the most common cause; early endoscopy (EGD) within 24 hours reduces re-bleeding and hospital stay. Risk stratification scores like Glasgow-Blatchford guide admission decisions. Endoscopic therapies reduce re-bleeding risk but impact on mortality varies. In anticoagulated patients with GI bleeds, resumption timing depends on bleeding risk and stroke risk (e.g., CHAD score). For esophageal variceal bleeding, management includes banding, octreotide, and antibiotics to reduce mortality. If bleeding recurs after two EGDs, transjugular intrahepatic portosystemic shunt (TIPS) placement is considered. Overall, coordinated multidisciplinary care, timely endoscopy, and tailored therapy improve outcomes in GI bleeding.

Keywords

gastrointestinal bleeding

upper GI bleed

peptic ulcer disease

endoscopy

risk stratification

esophageal variceal bleeding

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