Non-Variceal Upper GI Bleeding with Dr. Navin Kumar


Acute gastrointestinal bleeding is a broad topic with a range of manifestations, from scant hematochezia to the exsanguinating variceal hemorrhages. In this part 1 of 2 interviews (part 2), Dr. Navin Kumar discusses the management of acute non-variceal upper GI bleeding and the evidence behind some of the major interventions, such as transfusion threshold, proton pump inhibitors, and risk stratification scores.

00:00 introduction
01:50 sample patient case and initial assessment
06:17 differential diagnosis
10:37 nasogastric lavage
13:17 BUN/Cr ratio
16:00 transfusion threshold
22:42 proton pump inhibitors, bolus vs. continuous, before vs. after endoscopy
29:51 erythromycin before endoscopy
32:16 calling a GI consult
35:17 risk stratification tools
41:27 post endoscopy care and anti-thrombotic medications
46:32 summary and concluding remarks
50:53 credits

This podcast is part of the series, Curbside Consults, which complements the foundational information in Rotation Prep by taking a deep dive into key topics with expert clinicians and educators. As we explore the details of pathophysiology and critique the evidence behind clinical practice, these conversations are intended to give you better understanding of the topic and greater confidence when treating your patients.

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.