Upper gastrointestinal bleeding laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

In patients with acute Upper GI bleeding who are unstable rapid assessment and resuscitation should be initiated even before diagnostic evaluation. Once hemodynamic stability is achieved, a proper clinical history, physical examination, and initial laboratory findings are crucial not only in determining the likely sources of bleeding but also in directing the appropriate intervention.

Laboratory Findings

• Laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.
• Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult. Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult). Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate. Cuellar found the following results:

Determining whether blood is in the gastric aspirate

Finding	Sensitivity	Specificity	Positive predictive value (prevalence of 39%)	Negative predictive value (prevalence of 39%)
Gastroccult	95%	82%	77%	96%
Physician assessment	79%	55%	53%	20%

Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate. Holman found that by 120 seconds after the developer was applied, the Hemoccult test was positive on all control samples.