Gastrointestinal Bleeding (GIB) ]. Upper Gastrointestinal Bleeding (UGIB)

Notes
  • UGIB is defined as bleeding that occurs from a source proximal to the ligament of Treitz (which is between the duodenum and jejunum).
  • Causes include:

_Esophagus inflammation;

     *Esophagitis

     *Varices – distended veins that are

        associated with cirrhosis and portal

        hypertension.

     *Mallory-Weiss tear (after repeated                   incidences of vomiting)

_Gastritis

_Duodenitis

_Gastric and/or duodenal varices - also associated with cirrhosis and portal hypertension

_PUD

_Drugs such as warfarin and excessive alcohol intake

_Bleeding disorders (mainly congenital)

_Angiodysplasia (bleeding caused by continuous thining of blood vessel that line the GIT that result in their bursting).

_Dieulafoy's lesion (is characterized by a large tortuous arteriole mainly submucosal of the stomach. It erodes and bleeds easily).

_Aortic-enteric fistula (occurs mainly after aortic graft)

_Malignancies

_Polyps

Symptoms
  • Hematemesis
  • Cough-emesis
  • Coffee ground emesis (if it has been in the stomach for long).
  • Melena (when blood has been digested in the GIT)
  • Bright red blood in stool (brisk bleeding or hematochezia)
  • Fecal occult blood (FOB)
  • Gastroesophageal Reflux Disease (GERD), mainly due to esophagitis. It is gets worse after laying down or after meals and improves on sitting.
Diagnosis
  • History and physical examination
  • Endoscopy
  • Barium meal (after the patient is stable)
  • Full Blood Count (FBC)
  • ECG
  • Partial thromboplastin time (PTT) or thromboplastin time (PT)
  • Platelet count
  • Blood cross-matching
  • Liver function tests or any other tests as guided by symptoms and signs
  • Blood clotting tests
Management
  • Infusion with normal saline to maintain vital functions such as blood pressure and purse rates.
  • IV Octreotide (especially in the presence of hematemesis and history of liver disease or alcoholism. It is a powerful vasoconstrictor
  • For PUD refer to the standard treatment.
  • Variceal ligation is the treatment of choice of varices.
  • Sclerotherapy of varices can as well be done if variceal ligation is not possibility.
  • Hematemesis refractory to endoscopy treatment: transjagular intrahepatic portosystematic shunting (TIPS).
  • Esophageal varices: Tab Propranolol daily to reduce hepatic portal vein pressure.
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