Protocolo diagnóstico y terapéutico de la hemorragia digestiva alta en urgencias
| Autor: | J. Millastre Bocos, G. García Rayado, G. Hijos Mallada |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Gynecology
medicine.medical_specialty Gastrointestinal bleeding Medical treatment business.industry medicine.medical_treatment General Medicine medicine.disease 03 medical and health sciences 0302 clinical medicine Esophageal varices Melena 030220 oncology & carcinogenesis Therapeutic endoscopy medicine Portal hypertension 030212 general & internal medicine medicine.symptom Portosystemic shunt Varices business |
| Zdroj: | Medicine - Programa de Formación Médica Continuada Acreditado. 13:158-162 |
| ISSN: | 0304-5412 |
| Popis: | espanolLa hemorragia digestiva alta es una patologia frecuente en urgencias que se presenta como hematemesis o melenas. Las principales causas son la enfermedad ulcerosa peptica y la hemorragia digestiva por hipertension portal (HTP). El manejo inicial tiene como principales objetivos lograr la estabilidad hemodinamica, estratificar el riesgo, orientar la etiologia mas probable y comenzar el tratamiento medico segun esta sospecha. Se debe realizar una endoscopia precoz (menos de 24 horas) para confirmar el diagnostico y realizar maniobras terapeuticas. En el caso de la ulcera peptica, el tratamiento se basa en inhibidores de la bomba de protones en dosis altas y terapeutica endoscopica si se identifican estigmas de alto riesgo de resangrado. En el caso de varices esofagicas por HTP, el tratamiento con farmacos vasoactivos y antibiotico es primordial, ademas de la ligadura endoscopica con bandas, reservando el shunt portosistemico intrahepatico para casos refractarios. EnglishUpper digestive tract hemorrhage is a common emergency appearing as hematemesis or melena. Peptic ulcer disease and digestive gastrointestinal bleeding secondary to portal hypertension (PHT) are the commonest causes. The main goals of initial management are: to achieve hemodynamic stability, to stage the risk, to determine the most likely etiology and to begin medical treatment according with suspicion. In order to confirm diagnosis and to perform therapeutic maneuvers, early endoscopy has to be carried out (in less than 24 hours). If etiology is a peptic ulcer, treatment will be based on high-doses of proton pump inhibitors, and therapeutic endoscopy in presence of injuries at high risk for rebleeding. Vasoactive and antibiotic drugs as well as endoscopic band ligation are mandatory in the cases of esophageal varices caused by PHT; intrahepatic portosystemic shunt will be taken for refractory cases. |
| Databáze: | OpenAIRE |
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