Upper GI bleeding is any GI bleeding originating proximal to the ligament of Treitz.
Clinical Presentation
vomitingblood


Hematemesis and coffee-ground emesis suggest a UGI source. On physical examination, vital signs
may reveal obvious hypotension and tachycardia. Cool, clammy skin is an obvious sign of shock.
Abdominal examination may disclose tenderness, masses, ascites, or organomegaly. Perform rectal
examination to detect the presence of blood and its appearance, whether bright red, maroon, or
melanotic. Other findings include the presence of spider angiomas, palmar erythema, jaundice, and
gynecomastia which may suggest liver disease while petechiae and purpura may suggest an
underlying coagulopathy.
 
Differential diagnosis
 
Peptic ulcer disease, upper GI malignancy, oesophageal or gastric varices, esophagitis, Mallory-
Weiss tear, Boerhaave syndrome and arteriovenous malformation
 
Investigations
 
ABO Grouping and cross-matching, Complete Blood Count, Hemoglobin Level, Blood Urea Nitrogen
and Creatinine, Electrolytes, (Sodium, Potassium, Calcium Chloride), PT, PTT, INR, Liver Function
Tests, Lactate levels, Obtain an ECG in patients with underlying coronary artery disease and/or
Bedside Ultrasound
 
Non Pharmacological treatment
Maintain ABCs, give oxygen if needed
 
Pharmacological Treatment
Give blood If severe pallor, ongoing bleeding, Hb < 5g/dl and Hb < 7g/dl (with active bleeding)
·        Adults 2 units within 1hour and Paediatric 20ml/kg 1hour (whole blood) or 10ml/kg (pRBC)
·        If ongoing indication for blood, start transfusion in the following ratio: 1unit pRBCs
(20ml/kg in Paediatric): 1unit FFP (20mls/kg in Paediatric): 1unit PLT (20ml/kg in
Paediatric)
Give
A: 0.9% sodium chloride (IV)
OR
A: compound sodium lactate (IV); Adult 2000mls and Paediatrics 20ml/kg
AND
C: pantoprazole (IV); Adult 80mg stat, then infusion 8mg/hour for 3days,
Paediatrics1mg/kg stat (max 80mg) then infusion 1mg/kg/hour for 3days
OR
S: esomeprazole (IV) 40mg 24hourly for 3days
For patients with suspected variceal bleeding give:
S: octreotide (IV) Adult 50mg slow bolus, then infusion 50mcg/hour for 5days;
Paediatrics1mcg/kg/hour (maximum 50mcg/hour) for 5days
If features suggestive of cirrhosis; give
C: ciprofloxacin (IV) 500mg 12hourly for 7days
OR
B: ceftriaxone (IV) 2g 24hourly for 7days
 
DEFINITIVE CARE: Early Endoscopy and Intensive care unit admission (Refer Gastrointestinal
disease chapter)
 
REFERENCES;
•      Braunwald & Fauci (2001). Harrison’s principles of internal medicine 15th Ed.  Oxford: McGraw Hill
•      Davidson, S (2006). Principles and practice of medicine 20th Ed.  Churchill: Livingstone.
Kumar & Clark (2003) Textbook of clinical medicine. Churchill: Livingstone.
•      Douglas Model (2006): Making sense of Clinical Examination of the Adult patient. 1st Ed. Hodder Arnold
•      Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford handbook of clinical medicine. Oxford
•      Macleod, J. (2009). Macleod's clinical examination. G. Douglas, E. F. Nicol, & C. E. Robertson (Eds.). Elsevier Health Sciences.
•      Nicholson N., (1999), Medicine of Non-communicable diseases in adults. AMREF
•      Stuart and Saunders (2004): Mental health Nursing principles and practice. 1st Ed. Mosby
•      Swash, M., & Glynn, M. (2011). Hutchison's clinical methods: An integrated approach to clinical practice.