-THIS ESSAY IS IN REGARDS OF GI

-THIS ESSAY IS IN REGARDS OF GI BLEEDING AND THE COMMON MEDICATION THAT IS TAKEN -PLEASE PROVIDE ANY FEEDBACK OF IMPROVEMNTS AND OR WHAT YOU LIKED ABOUT IT -THANK YOU! Pathophysiology A gastrointestinal (GI) bleed is a sign of an underlying disease, not an illness itself. “Gastrointestinal bleedings can be divided in upper GIB (UGIB) and lower GIB (LGIB) based on the location, which can be proximal or distal to the ligament of Treitz,” (Alessia, G., Fabiola, F., Gian, L.D., et al, 2018). An upper GI bleed may occur in the esophagus, stomach, and duodenum. The most common causes of an upper GI bleed are peptic ulcer disease, variceal hemorrhage, and gastric cancers. Peptic ulcers commonly occur from NSAIDs or Helicobacter pylori infection which in result cause gastrointestinal bleeding. A lower GI bleed may occur in the small bowel, colon, or rectum. Common causes of lower GI bleed are colorectal cancer, Crohn’s disease, ulcerative colitis, and hemorrhoids. An upper gastrointestinal bleeding is visible in the form of hematemesis, hematochezia, or melena. A lower GI bleeding is not as apparent as an upper GI bleed and can present as occult blood in the stool. Risk Factors There are several risk factors that may cause a gastrointestinal bleed. Some risk factors that may lead to a GI bleed are chronic vomiting, alcoholism, medications, gastrointestinal surgery, hemorrhoids, ulcers, cancer, trauma, Crohn’s disease, and ulcerative colitis. The patient may present with the following symptoms: red bloody stools, black or tarry stools, coffee ground emesis, weight loss, abdominal cramps, dehydration, fever, anemia, and low blood pressure. The medications that may cause bleeding are the use of antiplatelets, and nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and selective serotonin reuptake inhibitors (SSRIs). These drugs are ulcerogenic and inhibit platelet activity. Corticosteroids delay the healing of ulcers which leads to a greater risk of bleeding. “SSRIs inhibit CYP3A4, which is responsible for the metabolism of corticosteroids,” (Hansten, P.D., Horn, J.R., 2015). Low-dose aspirin has a synergistic effect with anticoagulants, and they pose an additive risk of bleeding. Medication Action Related to Disease Pathophysiology Octreotide is a hormone and synthetic substitute but has an evident effect on upper GI bleeding. It is typically recommended for variceal bleeding that can develop in the esophagus or other parts of the upper GI tract. It decreases the inflow of blood to the portal system by constricting the splanchnic arterioles which reduces variceal pressure. Octreotide inhibits acid and pepsin secretion, which prevents the dissolution of clots formed at the site of the bleeding. The panel of the Nonvariceal Upper GI Bleeding Consensus suggested octreotide to be useful in patients with uncontrollable bleeding. This medication can be given orally, intravenously, or by intramuscular and subcutaneous injection. Octreotide can reduce blood flow in the gastrointestinal system, inhibit stomach acids and decrease the clumping of platelets. Medication The common side effects of the medication Octreotide are headache, fatigue, dizziness, nausea, diarrhea, abdominal pain, edema, joint pain, blurred vision hypoglycemia, and hyperglycemia. The life-threatening effects of Octreotide are numbness or tingling of the arms or legs, trouble breathing, irregular heart rate, yellowing of the skin or eyes, and unexplained pain in the back or right shoulder. More life-threatening effects are hypothyroidism, gallstones, and pancreatitis. The oral capsules of Octreotide should be taken on an empty stomach since food reduces absorption by 90%. Octreotide injections can be taken with or without food. There are no reported food or herbal remedies that have an interaction with Octreotide. According to Drugs.com Octreotide has approximately 147 drug interactions and some of the most common medications are Aspirin, Epinephrine, Ativan, Ciprofloxacin, Cymbalta, Dextrose, Lasix, and Tylenol. It is important to not use Octreotide with the medications listed above because it can cause the patient an increased risk of side effects. The nurse needs to monitor for hypoglycemia and hyperglycemia when administering Octreotide because this medication can alter the balance between insulin, glucagon, and growth hormone. It is important to monitor the patient’s fluid and electrolyte balance because Octreotide stimulates fluid and electrolyte absorption in the gastrointestinal tract. Labs that need to be monitored frequently are liver function tests, serum electrolytes and blood glucose. The nurse needs to monitor the patient for fecal fat and serum carotene as there is a possibility of drug-induced fat malabsorption. Education Plan Teach the proper technique for subcutaneous injection administration if self-medication is required after discharge Preferred sites for subcutaneous injections are the hip, thigh, and abdomen Injections need to be administered between meals and at bedtime to prevent GI side effects Rotate sites when self-injecting medication Store the medication in the original carton in the refrigerator and protect it from light You may store the immediate-release injection single-dose vials and ampules at room temperature for up to 14 days Discard any unused solution in single-dose ampules or vials after each use Your doctor will order certain lab tests during treatment to check your body’s response to Octreotide Call poison control helpline at 1-800-222-1222 for symptoms of overdose Symptoms of overdose are dizziness, irregular or slow hear rate, fainting, flushing, diarrhea, weakness, or weight loss Do not inject a double dose to make up for a missed dose. Conclusion The upper and lower origins of bleeding are the two main divisions of GI bleeding. An upper GI bleed can present with hematemesis, hematochezia, and melena whereas a lower GI bleed can present with occult blood in the stool. Peptic ulcers and esophageal varices are the most common cause of an upper GI bleed. The most common causes of a lower GI bleed are Crohn’s disease, Ulcerative colitis, and hemorrhoids. The medications that may cause a GI bleed are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, selective serotonin reuptake inhibitors (SSRIs), and antiplatelet medications. Octreotide is the medication of choice used for treatment of a gastrointestinal bleed. It’s important to educate the patient about the medication and its potential side effects. References Antunes, C., Copelin II, E.L. (2022). Upper Gastrointestinal Bleeding. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470300/ Alessia, G., Fabiola, F., Gian, L.D., et al. (2018). Clinical approach to the patient with acute gastrointestinal bleeding. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502216/ Clark, S., Engel, A., Kim, B.T., Li, A.E., Norton, I.D., Samra, J.S. (2014). Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231512/ Gastrointestinal Bleeding. (2022). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23391-gastrointestinal-gi-bleeding Hansten, P.D., Horn, J.R. (2015). Gastrointestinal Bleeding Due to Drug-Drug Interactions. Pharmacy Times. https://www.pharmacytimes.com/view/gastrointestinal-bleeding-due-to-drugdrug-interactions Laine, L. (2016). Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. The New England Journal of Medicine. Octreotide Injection. (2022). Medline Plus. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a693049.html#if-i-forget SCIENCE HEALTH SCIENCE NURSING NURSING 3600

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