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Page 1: Guia Nice de Hda

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A ??= =? ?A ??= =? ? 16: >?>? 16: >?>?

C=?= =?

&=: 13 ? 2012

?..</?/141

© NICE 2012. All rights reserved.

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C??C??

I?? .......................................................................................................................................................................... 3

&?-? .......................................................................................................................................................... 4

!J >=>??................................................................................................................................ 5

1 G? ............................................................................................................................................................................. 7

1.1 < >? ........................................................................................................................................................................ 7

1.2 ? ? ?= >?>? ............................................................................................................................. 7

1.3 *>? ?J................................................................................................................................................................ 8

1.4 #?>? ??-= =? ............................................................................................................................ 8

1.5 #?>? = =?...................................................................................................................................... 9

1.6 C?= =? ? ?? -=? ? ? ? $AID, ? == ......... 10

1.7 &>J J= =J == ? ? = ...................................................................................... 10

1.8 I?>? ? ? ? ........................................................................................................ 10

2 $ ? ? .........................................................................................................................12

3 I>=>?? ...............................................................................................................................................................14

4 ? =?.................................................................................................................................15

4.1 F== =?............................................................................................................................................................................... 15

4.2 $ICE J ............................................................................................................................................................................ 15

4.3 I?>? = ..................................................................................................................................................... 15

5 = $ICE ?..................................................................................................................................................16

6 +? =? ..................................................................................................................................................17

A? A: * G=? D=>? G, $?= C==? C? ? $ICE > ..........................................................................................................................................................................18

G=? D=>? G .................................................................................................................................................. 18

$?= C=?= G=? C? ........................................................................................................................................... 19

$ICE > ........................................................................................................................................................................... 19

C? =?................................................................................................................................................21

A =? ...........................................................................................................................................................22

Acute upper gastrointestinal bleeding: management (CG141)

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* =? 38.

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50 J.

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Acute upper gastrointestinal bleeding: management (CG141)

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I ? , >= ? = ?J ?= ? ?

>? ? .

F>= ? = = ? ?>? ? J ?.

Acute upper gastrointestinal bleeding: management (CG141)

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!!J >=>??J >=>??

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=?.

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??= =?.

F ? >? ??-= ??= =?, ?

==?:

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>= =? ?=?

M? >? ?=?.

???= =J ?= ? -= ? >?.

?=J J ???= =J ? >=J ==.

#?>? = =?#?>? = =?

Acute upper gastrointestinal bleeding: management (CG141)

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J= ? J ?? ? ?M>

= =?.

C? ?= ? J> ? (*I&) =? > =

? ?== J ? =?.

C?= =? ? C?= =? ? ?? -=? ? ? ? $AID, ? ==?? -=? ? ? ? $AID, ? ==

C?? =- ? ?J ?? = ? ? ?

??= =? ? > > ? .

Acute upper gastrointestinal bleeding: management (CG141)

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11 G?G?

* ==? ? ? == ?. * == =? =

> ? ? = ?.

1.1 Risk assessment

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??= =?:

B= M >?, ??

== <== ?J.

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0.

1.2 Resuscitation and initial management

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Acute upper gastrointestinal bleeding: management (CG141)

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1.2.7 * ? <? ? ? ??=

=? ? =? == ? =.

1.2.8 D ? >?? == ? == > =.

1.3 Timing of endoscopy 

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=? >>=J ?.

1.3.2 ?J ? 24 >? == ?

??= =?.

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? ? 330 J = ? ?

== >?.

1.4 Management of non-variceal bleeding 

E? >?E? >?

1.4.1 D ? ?=? >?J ? >? ??-

= ??= =?.

1.4.2 F ? >? ??-= ??= =?,

? ==?:

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1.4.3 D ? -? (? > ? H2-

??) ?J ? ??-=

??= =?.

Acute upper gastrointestinal bleeding: management (CG141)

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1.4.4 ? > ? ? ??-=

??= =? ? > ? > ?

?J.

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1.4.5 C? ?J, >? , == ?

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1.4.6 ?J ? -=

? >? >?J J.

1.4.7 ???= =J ?= ? -=

? >?. ?=J J ???= =J

? >=J ==.

1.5 Management of variceal bleeding 

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>? M? > ? , 5 J,

?= ? ?? 1

.

1.5.2 J= ? J ?? ?

?M> = =?.

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= .

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G G

1.5.5 ? ?? N-J=-2-J?J= ?

??= =? > .

Acute upper gastrointestinal bleeding: management (CG141)

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1.5.6 *I& =? > ? ?== J ?

?? N-J=-2-J?J=.

1.6 Control of bleeding and prevention of re-bleeding in patients on NSAIDs,

aspirin or clopidogrel

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.

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? ==? . * = ?=:

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? >> =?= > ? ?? ?>?

Acute upper gastrointestinal bleeding: management (CG141)

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? ? ?>?

?? ? ? >= ? ?? ?>?.

1 A > =? (? 2012), =? ? >? =?

> = , >>> ? >? 72 (3 J). &

= ?= =? >>J . I?> ?? -==

=? = ? ? >?.

Acute upper gastrointestinal bleeding: management (CG141)

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22 $ ? ?$ ? ?

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== ? .

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C=? (15 J ? J?).

B=? = ? ?>.

*>? Helicobacter pylori.

Acute upper gastrointestinal bleeding: management (CG141)

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33 I>=>??I>=>??

$ICE = = = ?? >=>? ?.

Acute upper gastrointestinal bleeding: management (CG141)

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44 ? =?? =?

4.1 Full guideline

* == =?, A ??= =?: >?>? ?? =

> ? ? = =?. I = J $?= C=?=

G=? C?.

4.2 NICE pathway 

* >>?? > =? ? ? ? $ICE J.

4.3 Information for the public

$ICE ?>? = =?? =?.

? $H ? =?J ?? > ?>? ?

? >= ??= =?.

Acute upper gastrointestinal bleeding: management (CG141)

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55 = $ICE ?= $ICE ?

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(2011).

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(2010).

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? 101 (2004).

Acute upper gastrointestinal bleeding: management (CG141)

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66 +? =?+? =?

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? =?.

Acute upper gastrointestinal bleeding: management (CG141)

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A? A: * G=? DA? A: * G=? D=>? G, $?= C===>? G, $?= C==??

C? ? $ICE >C? ? $ICE >

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C?=? ?, J= B=? H= $H F?? *

#< #< ??

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National Clinical Guideline Centre

B? H?B? H?

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A? GJ?A? GJ?

G=? C?

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H HJJ

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E

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C? =?C? =?

A= 2015A= 2015: >>?? 1.2.5 ? >? J

>?.

2012 2012: #? >???.

Acute upper gastrointestinal bleeding: management (CG141)

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A =?A =?

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C? $ICEC? $ICE

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Acute upper gastrointestinal bleeding: management (CG141)