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Upper Gastrointestinal Bleeding

Initial evaluation of upper GI bleeding should estimate the duration of hematemesis (vomiting bright red blood or coffee ground material), and volume of bleeding. A history of bleeding occurred after forceful vomiting (Mallory-Weiss Syndrome) should be sought.

Abdominal pain, melena, hematochezia (bright red blood per rectum), history of peptic ulcer, or cirrhosis prior bleeding episodes may be present.

Precipitating Factors. Use of aspirin, nonsteroidal anti-inflammatory agents, or anticoagulants should be sought.

Upper Gastrointestinal Bleeding Upper Gastrointestinal Bleeding Upper Gastrointestinal Bleeding

Physical Exam

General: Pallor and shallow rapid respirations may be present; tachycardia indicates a 10% blood volume loss; postural hypotension, with an increase in pulse of 20 and a decrease in systolic of 20, indicates a 20-30% loss.Icon

Skin: Delayed capillary refill, stigmata of liver disease (jaundice, spider angiomas, parotid gland hypertrophy) should be sought.Icon

Chest: Gynecomastia (cirrhosis).Icon

Laboratory EvaluationIcon

CBC, SMA 12, liver function tests, amylase, INR/PTT, type and cross upper gastrointestinal bleeding, gastrointestinal bleeding, GI bleeding PRBC, FFP. CBC q6h. Icon

Differential Diagnosis of Upper Bleeding: Peptic ulcer, gastritis, esophageal varices, Mallory Weiss tear (gastroesophageal junction tear caused by vomiting or retching), esophagitis, swallowed blood fromepistaxis, malignancy (esophageal, gastric), angiodysplasias, aorto-enteric fistula, hematobilia.Icon

If the bleeding appears to have stopped or has significantly slowed, medical therapy with H2 blockers, and saline lavage is usually all that is required.Icon

A minimum of two 14-16 gauge IV lines should be placed. 1-2 liters of

Mallory-Weiss SyndromeIcon

This disorder is defined as a mucosal tear at the gastroesophageal junction, frequently following forceful retching and vomiting.Icon

Treatment is supportive, and the majority of patients stop bleeding spontaneously. Endoscopic coagulation or operative suturing may rarely be necessary.Icon

Acute Medical Treatment of Peptic Ulcer DiseaseIcon

Ranitidine (Zantac) 50 mg IV bolus, then continuous infusion at 6.25-12.5 mg/h [150-300 mg in 250 mL D5W over 24h (11 cc/h)], or 50 mg IV q6-8h ORIcon