Upper gastrointestinal bleeding

8 Upper gastrointestinal bleeding





Questions



image What are the causes of upper gastrointestinal bleeding?

image What is the initial management priority?

image What is variceal bleeding and how would you manage it?

Upper gastrointestinal bleeding (UGIB) is a medical emergency and may become a surgical emergency. It is associated with significant morbidity and mortality. These patients must be stabilized before endoscopy, which is the investigation of choice and also allows therapeutic intervention.




Aetiology


The causes of UGIB are shown in Fig. 3.8.1.


image

Fig. 3.8.1 Causes of upper gastrointestinal bleeding.



Clinical features


The most common presentations are:


image haematemesis: vomiting with bright red blood, dark clots or coffee grounds; this may be repeated minor episodes or it may be a large lethal episode where thick clots are passed and the airway becomes compromised

image malaena: black, sticky, smelly, tar-like stools; bleeding is from proximal to and including the caecum

image anaemia: chronic UGIB may present with tiredness, symptomatic of anaemia; the patient may not have noticed associated malaena

image collapse or shock: acute presentation with tachycardia, hypotension, urine output < 30 ml/h

image weakness

image sweating

image palpitations, postural syncope and dizziness.


Management


The first priority is resuscitation, with particular care to secure the airway, followed by measures to stop the bleeding. Once the patient is stable, endoscopy is diagnostic and often therapeutic; it should be performed within 12 h. In urgent cases, the on-call endoscopy team should be summoned.


Initial management:


image ABC: protect the airway, gain intravenous access (two large venflons in two large veins) and restore circulating volume using crystalloids, colloids, O-negative and cross-matched blood

image bloods: FBC (anaemia may be profound), U&E, glucose, liver function tests, clotting, cross-match 4–8 units; consider arterial blood gases; decreasing haemoglobin and increasing urea suggest a gastrointestinal bleed
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Upper gastrointestinal bleeding

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