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Upper GI Bleed

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Topic updated on 05/21/17 7:29pm

Snap Shot
  • A 65-year-old man with a history of alcoholism, tobacco, and hypertension presents to the general surgery clinic, where he was referred for a further evaluation of blood in his stool. He reports occasional abdominal pain that is relieved transiently with meals. One episode of vomiting occurred with the pain. Recently, stools have been black. Examination reveals spider angiomas, but no palmar erythema or hepatosplenomegaly. The following angiogram was performed.
Introduction
  • Causes include
    • PUD
    • gastritis
    • esophageal varices
    • Mallory-Weis tear
    • gastric cancer
    • vascular abnormalities
    • esophagitis
  • Risk factors include
    • EtOH
    • tobacco
    • liver disease
    • NSAID use
    • vomiting
Presentation
  • Symptoms
    • hematemesis (coffee ground)
    • hematochezia
    • hypotension
  • Physical exam
    • abdominal pain
    • anorexia
    • bloody emesis
    • dark stools
    • blood per rectum
Evaluation
  • Labs
    • may have normal hematocrit
      • not accurate measure of blood loss
  • NG tube / lavage
  • Endoscopy
Treatment
  • Medical
    • IV fluid resuscitation and transfusions for hemodynamic stability
  • Surgical
    • endoscopy with banding or sclerotherapy
    • surgical exploration may be required if uncontrollable bleeding, though difficult if cervical or upper thoracic GI tract


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