小结
定义
病史和体格检查
关键诊断因素
- hematêmese
其他诊断因素
- vertigem/tontura
- hipotensão postural/ortostática
- disfagia
- odinofagia
- dor
- melena
- hematoquezia
- choque
- sinais de anemia
危险因素
- afecções que predispõem ao esforço para vomitar, vômitos e/ou esforços
- tosse crônica
- hérnia hiatal
- esforço para vomitar durante endoscopia ou outra intervenção
- consumo significativo de bebidas alcoólicas
- instrumentação prévia
- idade entre 30 e 50 anos
- sexo masculino
- uso de aspirina ou outros anti-inflamatórios não esteroidais
- soluços
- trauma abdominal contuso
- ressuscitação cardiopulmonar
诊断性检查
首要检查
- Hemograma completo
- ureia
- creatinina e eletrólitos
- testes da função hepática
- tempo de protrombina (TP)/razão normalizada internacional (INR)
- tempo de tromboplastina parcial (TTP)
- prova cruzada/tipagem sanguínea
- endoscopia digestiva alta (EDA) flexível
需考虑的检查
- tomografia computadorizada (TC) do tórax
- radiografia torácica
- angiografia
治疗流程
todos os pacientes
撰稿人
作者
Douglas G. Adler, MD, FACG, AGAF, FASGE
Professor of Medicine
Center Director
Center for Advanced Therapeutic Endoscopy (CATE)
Advent Health
Porter Adventist Hospital
Denver
CO
利益声明
DGA is a consultant for Merit Medical, Cook Endoscopy, Olympus America, and Boston Scientific.
鸣谢
Dr Douglas Adler would like to gratefully acknowledge Dr Shilpa Reddy and Dr Juan Carlos Munoz, the previous contributors to this topic.
利益声明
SR and JCM declare that they have no competing interests.
同行评议者
Joseph Sung, MD
Professor of Medicine
Department of Medicine and Therapeutics
Director
Institute of Digestive Disease
The Chinese University of Hong Kong
Hong Kong
利益声明
JS declares that he has no competing interests.
Imtiyaz Mohammed, MD
Consultant Gastroenterologist
Sandwell General Hospital
Lyndon
West Bromwich
UK
利益声明
IM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011.全文 摘要
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.全文 摘要
Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.全文 摘要
American College of Radiology. ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding. 2024 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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