Bleeding from the upper gastrointestinal tract (oesophagus, stomach and duodenum). It can be a medical emergency.
Cause
- Gastro-oesophageal varices
- Peptic ulcer disease/severe gastritis/cancer
- Mallory Weiss tear (a tear in the oesophageal mucosa caused by forceful retching)
Clinical features
- Vomiting of fresh blood (haematemesis)
- Coffee brown emesis (degraded blood mixed with stomach content)
- Melena: passing of soft dark red smelly stool
- Black stools (in case of minor bleeding)
Complications
- Acute hypovolaemia (if acute and abundant): syncope, hypotension, tachycardia, sweating
- Chronic anaemia (if subacute/chronic loss)
Diagnosis
- Endoscopy
Management
Supportive treatment
- Refer/admit to hospital
- IV line(s) and IV fluids (Normal saline or Ringer’s Lactate), start with 500 ml in 30 minutes and adjust according to BP
- Aim at systolic BP >90 mmHg and HR <105 bpm
- Blood grouping and crossmatching
- Hb may not reflect the amount of acute loss, consider amount of bleeding and clinical status to
decide for blood transfusion
- Hb may not reflect the amount of acute loss, consider amount of bleeding and clinical status to
- NGT and nothing by mouth (NPO)
- Urinary catheter
- Monitor vitals every 15-30 minutes
- Stop antihypertensives and diuretics
- Correct coagulopathy if present (e.g. in warfarin overdose, liver cirrhosis) with vitamin K 5 mg
slow IV and fresh frozen plasma
PUD, gastritis
- Ranitidine 50 mg IV every 8 hours (switch to oral omeprazole when possible, test for H.pylori)
Oesophageal varices
- Refer for endoscopic treatment and prophylaxis with beta blockers