A gastroenterology consult

Diseases that affect the gastrointestinal tract, liver, and pancreas are a diverse and vast group of disorders that encompass a wide array of pathology. Topics covered in this chapter focus mainly on gastrointestinal issues that affect patients in the intensive care unit setting. The chapter is organized by disorders commonly encountered in this patient population and outlines the appropriate approach to diagnosis and management. GASTROINTESTINAL BLEEDING Gastrointestinal bleeding (GIB) can present with hematemesis, coffee-ground emesis, blood from a nasogastric tube, hematochezia, maroon stool, or melena. Risk factors include a prior history of GI bleeding, liver disease, colon cancer, diverticulosis, prior abdominal surgery, angiodysplasia, and nonsteroidal anti-inflammatory drug (NSAID) and anticoagulant use. It is important to determine the location of bleeding, as this will guide subsequent management. Massive GI hemorrhage is potentially life-threatening and prompt diagnosis and treatment is imperative. Location of Bleeding ▪ Upper GI bleeding by definition occurs proximal to the ligament of Treitz. It may present as hematemesis, blood observed from the nasogastric tube, melena (present in 70% of upper GI bleeds), or heme-positive stools. ▸ If rectal blood is melenic, it is from a source proximal to the ligament of Treitz. However, a briskly bleeding upper GI bleed can lead to hematochezia in up to 15% of cases. ▸ Etiologies of upper GI bleeding: peptic ulcer disease (50% of upper GI bleeds), gastritis, Mallory-Weiss tears, varices, erosive esophagitis, vascular malformations #x25B8; H. pylori infection has not been associated with increased risk of gastrointestinal bleeding in the ICU setting.