Variceal and Lower 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 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
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.