Day 1 - Upper GI bleed

Defined as: Gastrointestinal Bleeding proximal to the ligament of Treitz

Physical Manifestations: Hematemesis, Melena, Maroon Stool

Common Etiologies:

  • Peptic Ulcer Disease

    • Drug induced - NSAIDs

    • H. Pylori

  • Esophageal Varices

  • Malignancy

  • Mallory Weiss Tear

  • Angiodysplasia (ie: GAVE)

Investigations:

  • CBC, Electrolytes, Urea, Creatinine, Liver enzymes, INR, PTT, Group and Screen

    • Elevated BUN disproportionate to creatinine (>10x creatinine) may indicate UGIB

Acute Treatment of UGIB:

  1. Ensure Stability - ABC’s

    • If aLOC, not protecting airway - intubation is appropriate

  2. Pantoprazole 80mg IV bolus, then 8mg/hr or 40mg IV BID

  3. Octreotide 50mcg x 1 IV bolus, then 50mcg/h if patient is known to have cirrhosis, portal hypertension or esophageal varices

  4. In patients with suspected or known variceal bleed (i.e.-hx of Cirrhosis) - early antibiotic treatment for SBP prophylaxis is associated with mortality benefit

    • Ceftriaxone 1g IV q24h x 7 days

      • Penicillin allergic patients can use Floroquinolone

  5. Fluid resuscitation - target urine output 0.5-1ml/kg/hr

    • Crystalloids preferred (Ringer’s Lactate over Normal Saline if patient is requiring large volume resuscitation)

  6. Blood Transfusion?

    • Based on TRICC trial - only for patients Hb<70, or Hb<90 for cardiac patients

  7. Consider reversal of anti-coagulation in massive UGIB

  8. Repeat CBC q4-6 hours until stable.

  9. GI consultation for urgent endoscopy

    • PPI therapy as well as indications for discharge will be guided by findings on endoscopy

Last updated: April 30, 2020

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