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In this episode of the Emoroid Digest Podcast, we go to Canada for our guest Dr. Alan Barkun and discuss the guidelines from the American College of Gastroenterology on Upper Gastrointestinal and Ulcer bleeding. Dr. Barkun is professor of Medicine in the Division of Gastroenterology at McGill University and the McGill University Health Centre, Montréal, Canada. He is a recipient of the DG Kinnear Chair in Gastroenterology at McGill University. Dr. Barkun has published over 800 peer-reviewed articles and abstracts and has given over 600 international presentations on emerging digestive endoscopic technologies, with an emphasis on methodological, clinical and cost-effectiveness trials of treatments for upper gastrointestinal bleeding (UGIB), bilio-pancreatic diseases, and colorectal cancer screening. Host: Dr. Chuma Obineme (GI Fellow) – https://twitter.com/TypicallySilent Co-Host: Dr. Jason Brown - https://med.emory.edu/directory/profile/?u=JMBROW2 Guest: https://www.mcgill.ca/gastroenterology/alan-barkun Link to Guideline: https://pubmed.ncbi.nlm.nih.gov/33929377/ Link to Emoroid Digest Visual Summary: https://twitter.com/EmoryGastroHep/status/1438626435527155713?s=20 Link to Emoroid Digest Website: https://med.emory.edu/departments/medicine/divisions/digestive-diseases/education/emoroid-digest.html
Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Have you heard of Goody's or BC powder? Can you guess how much NSAIDs are in each packet!? Its a wonder how few people get GI bleeds when you read the label on these OTC meds. Let's talk UGIB, diagnosis, management, and pearls and pitfalls.
Dr. Navin Kumar, an attending Gastroenterologist at Brigham and Women's Hospital, medical educator at Harvard Medical School, and co-founder of the Run the List podcast, and Dr. Walker Redd, a Gastroenterology fellow at the University of North Carolina and co-founder of RTL, discuss variceal upper GI bleeding to build upon the principles discussed in the non-variceal UGIB episode. In this episode, Navin and Walker use a case discussion to emphasize the importance of recognizing which patients are at risk for variceal bleeding, what distinguishes variceal GI bleeding from other sources of GIB, initial steps in management, and additional considerations to keep in mind when caring for these patients.
In this episode we discuss a recent paper published jointly in The American Journal of Gastroenterology and the Journal of the Canadian Association of Gastroenterology entitled American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period and co-authored by a Canada – United States team of experts.The interview with co-authors Dr Alan Barkun and Dr Jim Douketis covers the rationale for the new guidelines as well as the implications for clinicians. Dr Barkun is Professor of Medicine in the Division of Gastroenterology at McGill University and the McGill University Health Centre, Montréal, Canada. He is current holder of the DG Kinnear Chair in Gastroenterology at McGill University. Recipient of many national and international awards, Dr. Barkun has published over 400 peer-reviewed articles and abstracts and has given over 600 international presentations on emerging digestive endoscopic technologies, with an emphasis on methodological, clinical and cost-effectiveness trials of treatments for upper gastrointestinal bleeding (UGIB), bilio-pancreatic diseases and colorectal cancer screening. He is also the current President of the colorectal Cancer screening implementation committee for the province of Quebec. ANDDr. Douketis is Staff Physician in General Internal Medicine and Clinical Thromboembolism at St. Joseph's Healthcare Hamilton. He is a Professor of Medicine and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University. Dr Douketis is past-president of Thrombosis Canada.Dr. Douketis' research interests include perioperative antithrombotic therapy, prognosis of patients with venous thromboembolism, hormonal therapy and thrombosis, prevention of venous thrombosis in medical patients, and clinical practice guideline development.Dr. Douketis is a Fellow of the Canadian Academy of Health Science, Associate Editor of McMaster Textbook of Internal Medicine, Editor-in-Chief of Canadian Journal of General Internal Medicine, Deputy Editor of Annals of Internal Medicine ACP Journal Club, and Associate Editor of Thrombosis and Haemostasis. He has over 350 peer-reviewed publications.Related Thrombosis Canada Resources:DOAC Bleeding Management Clinical Guide: [LINK]DOAC Perioperative Management Clinical Guide: [LINK]Perioperative Anticoagulant Algorithm: [LINK]Follow us on Twitter: @thrombosiscanReference:Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Journal of the Canadian Association of Gastroenterology. 2022 Apr;5(2):100-1Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
In this week's episode we are happy to welcome Dr Farhad Peerally, gastroenterology registrars in East Midlands to discuss a comprehensive approach to UGIB management. Essential listening.
Core Questions Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4 Wisecracks Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?
Core Questions Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4 Wisecracks Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?
It’s the JournalFeed Podcast for the week of Aug. 31 - Sept. 4, 2020. We cover a review of acute ischemic stroke, ACP/AAFP musculoskeletal pain guidelines, antibiotics for cirrhosis with upper GI bleed, early norepinephrine for septic shock, and the best way to tape an ETT so it won’t come out.
Background: Upper endoscopy allows for the identification of the source of bleeding as well as hemostatic treatment for actively bleeding lesions In patients with upper... The post REBEL Cast Ep82: Timing of Endoscopy for UGIB appeared first on REBEL EM - Emergency Medicine Blog.
Pearls for Patients with Acute UGIB
Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the December 04, 2018 issue
From ECHONooga, Dan Rauh and Bill Hinckley bring us their talks on bleeding. Dan Rauh will discuss coagulopathy/anticoagulants. Do you understand the difference between a NOAC, VKA, INR, 4 factor PCC AND FFP? Do the concepts of intrinsic and extrinsic pathway trigger a migraine? Not anymore!!! Who, when and how to reverse will be covered as well as the most important question....”How do I do that?!” Dr. Bill Hinckley will bring his talk, Master of the Massive UGIB. We’re experts in managing hemorrhagic shock from trauma, and we know that in bleeding trauma patients, the care that we bring to the patient is at least as important as the rapid transport we provide to the Level 1 Trauma Center. I get stoked about massive UGIBs in the same way that we all get fired up to take care of that MVC patient with severe TBI and florid shock. Why? Because I know there’s very little the accepting GI doc and intensivist have that my partner and I don’t have in terms of definitive care for that massive UGIB patient. I know, and you will too, that in a short period of time we can have a huge impact on that patient’s morbidity and mortality. And because I’m anosmic, so the aroma of melena doesn’t bother me in the least. Even if you’re not anosmic, I think I can get you pumped up about taking care of massive UGIBs too. You will hear a Moment of Silence during Dr. Hinckley's talk. Here's why: All classes were paused for a moment of silence at 1120 in remembrance of Duke Lifeflight Crew Crystal Sollinger, Kristopher Harrison, Jeff Burke, and Mary Bartlett.
This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage EMCrit:
This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they're not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don't forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage
This episode covers Chapter 30 of Rosen's Emergency Medicine. Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB 4) List 6 low-risk criteria D/C of GIB 5) List components of the Rockall and Glasgow-Blatchford score Wisecracks: 1) Describe the insertion of a Blakemore tube 2) List 6 causes of false positive stool guaic
This episode covers Chapter 30 of Rosen's Emergency Medicine. Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB 4) List 6 low-risk criteria D/C of GIB 5) List components of the Rockall and Glasgow-Blatchford score Wisecracks: 1) Describe the insertion of a Blakemore tube 2) List 6 causes of false positive stool guaic