Upper gastrointestinal bleeding is any GI bleeding originating proximal to the ligament of Treitz.
Clinical Presentation of upper gastrointestinal bleeding
- Hematemesis and coffee-ground emesis suggest an upper Gastrointestinal bleeding source.
- On physical examination, vital signs may reveal obvious hypotension and tachycardia.
- Cool, clammy skin is an obvious sign of shock.
- Abdominal examination may disclose tenderness, masses, ascites, or organomegaly.
- Perform rectal examination to detect the presence of blood and its appearance, whether bright red, maroon, or melanotic.
- Other findings include, the presence of spider angiomas, paimar erythema, jaundice, and gynecomastia which may suggest liver disease while petechiae and purpura may suggest an underlying coagulopathy.
- Peptic ulcer disease, upper GI malignancy, oesophageal or gastric varices, esophagitis, Mallory Weiss tear, Boerhaave syndrome and arteriovenous malformation
- ABO Grouping and cross-matching,
- Complete Blood Count
- Hemoglobin Level
- Blood Urea Nitrogen and Creatinine
- Electrolytes, (Sodium, Potassium, Calcium Chloride)
- Liver Function Tests
- Lactate levels
- Obtain an ECG in patients with underlying coronary artery disease and/or Bedside Ultrasound
Treatment for upper gastrointestinal bleeding
Non Pharmacological treatment
- Maintain ABCs, give oxygen if needed
Give blood if:
- severe pallor
- ongoing bleeding
- Hb < 5g/dl and Hb<7g/dl (with active bleeding)
Adults 2 units within 1hour and Paediatric 20ml/kg 1hour (whole blood) or 10ml/kg (pRBC)
- If ongoing indication for blood, start transfusion in the following ratio: 1unit pRBCs (20ml/kg in Paediatric): 1unit FFP (20mls/kg in Paediatric): 1unit PLT (20ml/kg in Paediatric)
A: 0.9% sodium chloride (IV)
A: compound sodium lactate (IV);
Adult 2000mls and Paediatrics 20ml/kg
C: pantoprazole (IV);
Adult 80mg stat, then infusion 8mg/hour for 3days.
Paediatrics 1mg/kg stat (max 80mg) then infusion 1mg/kg/hour for 3days
S: esomeprazole 40 mg (IV) 24hourly for 3days.
For patients with suspected variceal bleeding give:
S: octreotide (IV)
Adult 50mg slow bolus, then infusion 50mcg/hour for 5days;
Paediatrics 1mcg/kg/hour (maximum 50mcg/hour) for 5days
If features suggestive of cirrhosis; give
C: ciprofloxacin (IV)
- 500mg 12hourly for 7days
B: ceftriaxone (IV)
- 2g 24hourly for 7days
Early Endoscopy and Intensive care unit admission