Upper GI Bleeding

Question 1

What is upper gastrointestinal bleeding (UGIB)?

Answer 1

Refers to gastrointestinal blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction.

Question 2

Give examples of causes of UGIB

Answer 2

• Peptic ulcer disease (26%)
• Gastritis/erosions (16%)
• Oesophagitis (17%)
• No cause found (12%)
• Erosive duodenitis (9%)
• Varices (8%)
• Portal hypertensive gastropathy (4%)
• Mallory-Weiss tears (3%)
• Malignancy (3%)
• Vascular ectasia (2%)

Question 3

What scoring system is used to identify patients at risk of adverse outcome after acute upper GI bleeding?

Answer 3

Rockall Scoring System

Question 4

How can UGIB present?

Answer 4

Acute UGIB can manifest in a variety of ways, with or without haemodynamic compromise, including haematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube and melaena. Haematochezia (bright red blood per rectum) may rarely occur in patients with an extremely brisk UGIB.

Question 5

Briefly describe the history of UGIB

Answer 5

• Nausea and vomiting
• Malena
• Haematochezia
• Diet
• Constitiutional symptoms
• Medications
• History of alcoholism or chronic liver disease
• Social history

Question 6

How can a patient’s anaemia or volume status be assessed in UGIB?

Answer 6

Vital signs can be used to estimate the patient’s volume status. Blood pressure may remain normal initially, so increased heart rate is a more sensitive measure of circulatory status. If the patient’s other comorbidities are not contraindications, tachycardia with hypotension should trigger aggressive volume resuscitation. If the patient is stable, orthostatic blood pressures should be obtained. Capillary refill, moisture in the mucous membranes, and absence of pallor can also assist in assessing the degree of anaemia/hypovolaemia.

Question 7

What blood tests should be ordered for an UGIB urgently? And why?

Answer 7

FBC and coagulation studies. Because patients with UGIB can experience rapid clinical deterioration, blood should be sent for typing and cross-matching in the event that blood products become necessary.

Question 8

What is the role of endoscopy in UGIB?

Answer 8

Endoscopy is highly effective in diagnosing and treating most causes of UGIB. It is also associated with a reduction in blood transfusion requirements, length of stay in the intensive care unit, and total hospital stay.

Question 9

Briefly describe the treatment of UGIB

Answer 9

Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.