upper gastrointestinal bleeding symptoms,clinical manifestation of upper gastrointestinal bleeding - U of health list
Information about upper gastrointestinal bleeding complications,upper gastrointestinal bleeding differential diagnosis,treatment of upper gastrointestinal bleeding ect info
Here you can find information about etiology and pathology of upper gastrointestinal bleeding,laboratory examination of upper gastrointestinal bleeding,upper gastrointestinal bleeding prevention
Commonest cause is peptic ulcer with a history of proven ulcer or ulcer-like dyspepsia in approx 80% of cases, commonly with use of aspirin or NSAID. Infection with Helicobacter pylori less common in bleeding ulcers than uncomplicated ones. Severe ulcer bleeding is caused by erosion of the artery by the ulcer with the severity depending on the size of ulcer and the defect. Where it is >1mm in size, unlikely to stop spontaneously and unresponsive to endoscopic treatment. Large ulcers in the posterior part of the duodenal cap can erode the gastroduodenal artery and cause rapid bleeding.
Bleeding from gastric erosions, vascular malformations or oesophagitis normally resolves spontaneously.
Malory-Weiss tears are caused by retching usually associated with alcohol abuse and other signs of GI disease, e.g. peptic ulcer, gastroenteritis or have a cause of vomiting unrelated to the GI tract. Normally, bleeding stops spontaneously.
Bleeding from upper GI neoplasm is normally not severe and rarely fatal on its own.
Oesophageal varices are relatively uncommon but often cause severe bleeding and are associated with other features of liver disease, e.g. ascites, jaundice, splenomegaly and fluid retention.
In patients who have undergone aortic aneurysm surgery need to consider aortoduodenal fistula if develop profuse bleeding.
Incidence 47-116/100,000 population accounting for approx. 2500 hospital admissions/year in UK.
Risk Factors In many cases, associated with use of NSAIDs or aspirin. 3 Causes of acute upper GI bleeding are:
Peptic ulcer 40% No obvious cause 24% Oesophagitis 10% Erosive disease 6% Varices 5% Malory-Weiss tear 5% Neoplasm 4%.
Investigations Hb (may be normal during acute stages), U & Es (raised blood urea suggests severe bleeding), liver function tests, prothrombin time. Cross-match for transfusion (2 units usually enough unless extreme bleeding).
Resuscitation Resuscitate patient before undertaking endoscopy. When pulse rate is >100 bpm or systolic BP <100 mmHg give crystalloid, e.g. normal saline (except in suspected liver disease where can precipitate ascites). If giving blood transfusion aim to maintain Hb >10g/dl.