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Hola, supongo que nadie habrá errado en esta pregunta salvo yo, pero por si acaso quería consultar, no tengo tan claro que se le deba dar el alta hospitalaria a un paciente que presenta restos de hematina,en el sangarado. Harrison en el tomo pagina 267 de la 16ª edición dice que habría que ingresarlo tres días, no sé, ¿Qué opinan ustedes??
 
Endoscopic Triage: Cost-Effective Care for Low-Risk Patients

Although it may seem intuitively obvious that endoscopy would improve outcomes, randomized trials have indicated that diagnostic endoscopy alone does not improve mortality, rebleeding rates, need for surgery, or hospital stay. The overwhelming majority (75 to 80%) of patients with bleeding ulcers stop bleeding spontaneously, limiting the impact of early endoscopy for these patients. Nevertheless, prospective studies show that urgent endoscopy in all patients with acute nonvariceal upper gastrointestinal bleeding identifies 20 to 30% of patients who meet both clinical and endoscopic criteria for a low risk of rebleeding and morbidity; these patients can be safely treated as outpatients, thereby dramatically reducing the cost of care. Conversely, patients with a high risk of rebleeding, by the same criteria, can undergo early endoscopic therapy, ideally before admission, and be triaged to more intensive hospital care. Urgent endoscopy as a triage tool is cost-effective care for upper gastrointestinal bleeding.


Scores for finding: (del caso)
Age <60 years
Shock Heart rate <100 beats per minute and systolic blood pressure ?100 mm Hg
Comorbidity None
Total Score: 0

Mortality of acute upper gastrointestinal bleeding based on characteristics assessed at the initial presentation. A score of 3 or less indicates a low clinical risk (mortality ?12%), whereas a score of 4 or more indicates a high clinical risk (mortality >20%).


Endoscopic classification of ulcers has been shown repeatedly to predict accurately the rates of rebleeding, morbidity, and mortality. Patients without high-risk stigmata (those with a clean ulcer base or flat, pigmented spots) have an extremely low rate of rebleeding and a negligible mortality.

RISK OF REBLEEDING AND DEATH BASED ON ENDOSCOPIC FINDINGSEndoscopic Finding
Risk of Rebleeding (%) Mortality (%)
Active bleeding 55 11
Visible vessel 43 11
Adherent clot 22 7
Flat spot 10 3
Clean base 5 2


Fuente: Cecil 23 ed
Bastante claro, si no tiene estigmas de alto riesgo de sangrado, se va a su casa.
 
Harrison Tomo I Pág. 269. Viene un esquema en el que si entendemos el punto de hematina como coágulo adherente (no se si me equivoco al entenderlo así, ya sabemos como es de quisquillosa la semántica), habría que darle IBP iv e ingresarlo.
 
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