Upper gastrointestinal bleeding resident survival guide

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

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Shown below is an algorithm summarizing the approach to [[disease name]].

Characterize the symptoms:

❑ Blood in vomiting
❑ Coffee ground emesis
❑ Black, tarry stools
❑ Frank blood in stools
❑ Maroon colored stool
❑ Abdominal pain
❑ Altered mental status
❑ Dizziness
❑ Syncope
❑ Palpitations

Elicit past medical history

❑ History of previous GI bleed
❑ Patient taking anticoagulants
❑ History of NSAIDs intake
❑ History of other comorbities

Physical examination

Abdominal examination

❑ Abdominal tenderness
❑ Involuntary guarding
❑ Bowel sounds

Hyperactive: Suggests UGIB

Hypoactive: Suggests mesenteric ischemia or ileus

❑ Signs of hypovolemia:

Severity of blood loss	Signs
Mild to moderate	Resting tachycardia
15% blood loss	Orthostatic hypotension
40% blood loss	Hypotension
Shock	Cold clammy extremities, Weak and thready pulse

Order tests

❑ Order EKG and cardiac enzymes to rule out myocardial infarction in elderly patients

Initial assessment

❑ Ensure normal breathing and clear airway
❑ Monitor vital signs
❑ Cardiac monitoring
❑ Assess mental status
❑ Monitor urine output

Initial resuscitative measures

❑ Nil per oral
❑ 2 large bore IV lines
❑