Page 184 - Critical Care Notes

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GI

Pathophysiology
Impaired liver structure and function →↑ resistance to portal blood flow at portal
vena and inferior vena cava and ↑ pressure in the liver →↑ portal venous pres-
sure (portal hypertension) → collateral circulation from the liver to the veins of the
esophagus, spleen, intestines, and stomach → engorged and dilated blood ves-
sels → esophagogastric varices → rupture → massive hemorrhage → death.
Clinical Presentation
■ Vomiting of blood (hematemesis) or massive bleeding (hematochezia)
■ Tachycardia; ↓ BP; cool, clammy skin; decreased urine output
■ Bright red to black stools, indicating blood in feces
■ Abdominal pain and weakness
■ Other signs of UGI bleeding
Rockall Scoring System to Predict Mortality
in Acute UGI Bleeding

Score Score Score Score
Variable of 0 of 1 of 2 of 3
Age (yr) <60 60–79 ≥80
Shock No shock
HR <100 bpm HR >100 bpm HR >100 bpm
SBP >100 mm SBP <100 mm SBP <100 mm
Hg Hg Hg
Comorbidity No major Heart failure, Renal
comorbidity ischemic heart failure,
disease, any liver
major failure,
comorbidity metastatic
cancer
Diagnosis Mallory- All other Malignancy of
Weiss tear, diagnoses: e.g., UGI tract
no pathology esophagitis,
gastritis, peptic
ulcer disease,
varices
Continued
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