Upper GI bleed

• Urgent condition. Often associated with high morbidity and mortality
• The severity of bleed depends on origin (venous, capillary or arterial)
• • coffee ground vomitus indicated that blood has been in contact with gastric secretions
  • melena indicates slow bleeding from upper GI source
• Causes

  • meds (corticosteroid, NSAIDs)
  • esophageal varices or esophagitis
  • gastric cancer
  • PUD
  • polyps
  • liver and renal failure
• Subjective assessment

  • past medical history
  • medication use
  • nausea and vomiting
  • weight loss
• Objective assessment

  • stool (melena, diarrhea)
  • weakness, dizziness, fainting
  • epigastric pain and rigid abdomen
  • clammy cool pale skin
  • agitation or decrease in LOC
  • decrease Hct and Hb
  • guiac positive stool (occult blood)
• Diagnostic studies

  • gastroscopy
  • angiography
  • CBC
  • gaiac test for occult blood
• Management

  • close monitoring of VS, symptoms of shock
  • IV insertion for fluid and blood replacement
  • PPI continuous IV infusion
  • endoscopic therapy
  • surgery