Run Time: 6 minutes
Author: Chris Holmes M.D.
- There was a 50% mortality rate from upper GI bleeds and 20% of cases were unrecognized.
- Management: The thought was that every patient had peptic ulcer disease or variceal bleeding.
- First check for liver disease with the bromosulfophthalein excretion test – does not work for people with GI bleed. Then perform a splenoportogram – inject the pt with contrast dye and have enthusiastic radiologist view the images, simultaneously hook up the patient to a manometer, if the splenic pressure is greater than 300 the patient probably had liver disease and variceal bleeding.
- Patients were also subject to a rigid endoscopy, which was state of the art and was just beginning to be practiced clinically.
- Patients were also given a Levine tube with ice and saline solution irrigation.
- Fresh blood was administered & neomycin was given to everyone.
- Surgery was another mainstay of treatment. Patients were given a Blakemore tube and it was left in for 2 days.
- There were no H2 blockers, tagamet came out in approximately 1980. No PPIs, so antacids every 1 hour given through the blakemore tube included calcium carbonate alternating with milk.
Link to Podcast: http://medicalminute.madewithopinion.com/gi-bleed-1966/