Upper gastrointestinal bleeding is defined as hemorrhage that occurs proximal to the ligament of treitz. its potentially life threatening condition which requires hospitalization most of the times. And the most common cause of upper GI bleed is gastric and duodenal ulcers.

 

Causes of upper GI bleeding

Esophageal causes	Esophageal varices, esophagitis, esophageal ulcers, esophageal cancer, Mallory weiss tear.
Gastric causes	Gastric ulcer, gastritis, gastric varices, gastric cancer, Dieulafoy’s lesion, gastric antral vascular ectasia or watermelon stomach
Duodenal causes	Duodenal ulcer, aorto enteric fistula, hematobilia (bleeding from biliary tree)
Pancreatic causes	Pancreatic pseudo cyst, pancreatic pseudo aneurysms, hemosuccus pancreaticus (bleeding form pancreatic duct)

 

Signs and symptoms

• Hematemesis (vomiting blood)
• Vomitus with coffee brown consistency
• Melena (black colored stools)
• Hematochezia (blood in the stools)
• Dyspepsia
• Sycope
• Epigastric pain
• Heart burn
• Diffuse abdominal pain
• Dysphagia
• Weight loss
• Jaundice
• Weakness
• Shortness of breath

Test and diagnosis

• Complete blood count
• Renal function test (blood urea and serum creatinine)
• Coagulation profile (prothrombin time and INR)
• Serum electrolytes
• Liver function test
• plasma fibrinogen  level
• Stool for occult blood
• Upper GI endoscopy
• ECG

Complications of GI bleed

• Anemia
• Dehydration
• Chest pain
• Blood loss
• Shock
• Death

Treatment

Medical line of management

• The goal of medical therapy is to correct shock and coagulation abnormalities and to stabilize the patient.
• Stabilize the patient with intravenous fluids (plasma expanders) and blood products.
• Use of proton pump inhibitors (Esmoprazole, Pantoprazole, Rabeprazole)
• Octreotide is a somatostatin analog, used in the management of both variceal and non-variceal bleed.
• Terlipressin is a vasopressin analog used commonly used in upper GI bleed.
• Helicobacter pylori
• Omeprazole + Clarithromycin + Tinidazole
• Lansoprazole + Amoxicillin + Clarithromycin
• Bismuth + Metronidazole + Tetracycline + H2 receptor antagonist

 

Surgical Care

Various endoscopic techniques for achieving hemostasis

• Injection of vasoactive agents
• Injection of sclerosing agents
• Bipolar electro coagulation
• Band ligation
• Argon plasma coagulator
• Laser photocoagulation
• Rubber band ligation
• Application of haemostatic materials, including biologic glue

 

Most common operative procedure used for bleeding duodenal and gastric ulcer

• Truncal vagotomy and pyloroplasty with suture ligation of the bleeding ulcer
• Truncal vagotomy and antrectomy with resection
• Proximal (highly selective) gastric vagotomy with duodenostomy and suture ligation of the bleeding ulcer