Podcast #147: GI Bleed – 1966

a20e0189-4563-441d-a603-20ea49b3652cRun Time: 6 minutes

Author: Chris Holmes M.D.

Educational Pearls:

  • 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/

References: http://www.thennt.com/nnt/proton-pump-inhibitors-for-acute-upper-gi-bleeding/

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