Upper GI Bleeding
Upper GI bleeding (UGIB) is defined as bleeding derived from a source proximal to the ligament of Treitz. The image shows an ulcer with active bleeding.Signs and symptoms of acute UGIB are hematemesis, melena, hematochezia, syncope, dyspepsia, epigastric pain, dysphagia. The workup may include orthostatic blood pressure (blood pressure in an upright position), complete blood cell count, hemoglobin level, blood urea nitrogen, endoscopy, Computed tomography (CT) angiography (CTA). Treatment may include the following: Secure the airway Insert bilateral, 16-gauge (minimum), upper extremity, peripheral intravenous lines Replace each milliliter of blood loss with 3 mL of crystalloid fluid In patients with severe coexisting medical illnesses, pulmonary artery catheter insertion for monitoring hemodynamic cardiac performance Foley catheter placement for continuous evaluation of urinary output as a guide to renal perfusion Endoscopic hemostatic therapy for bleeding ulcers and varices Surgical repair of perforated viscus For high-risk peptic ulcer patients, high-dose intravenous proton pump inhibitors Mesenteric angiography with embolization therapy