Curbside Consults Podcast

Published June 13, 2019

Acute gastrointestinal bleeding is a broad topic with a range of manifestations, from scant hematochezia to the exsanguinating variceal hemorrhages. In this part 2 of 2 interviews (part 1), Dr. Navin Kumar discusses the management of variceal and lower GI bleeding and the evidence behind some of the major interventions, such as octreotide, antibiotics prophylaxis, and transjugular intrahepatic portosystemic shunts. 

00:00 introduction
01:21 variceal bleeding section, sample patient case
05:44 APRI score
06:45 pathophysiology
10:22 use of blood products
14:43 octreotide
15:25 infection prophylaxis
21:09 banding and TIPS
29:13 care after endoscopic banding
31:00 prophylaxis with beta-blockers
35:22 lower GI bleeding section, overview of assessment
38:48 diagnostic tests for lower GI bleeding
48:13 summary and concluding remarks
52:58 credits

The Curbside Consults series complements the foundational information in NEJM R360 Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

Dr. Kumar is an Instructor in Medicine at Harvard Medical School and Staff Physician in the Division of Gastroenterology at the Brigham and Women’s Hospital (BWH) in Boston, MA. He spends a significant portion of his time teaching and advising medical students as the Associate Clerkship Director of the BWH Internal Medicine Clerkship. His education research focuses on procedural teaching and assessment of trainees.
Mike Mi is a 2017-2018 NEJM Editorial Fellow and a hospitalist at Beth Israel Deaconess Medical Center. He graduated from Harvard Medical School and completed his internal medicine training at BIDMC.
Balim Senman is a 4th year medical student at University of Massachusetts Medical School and applying for residency in Internal Medicine.