UPPER GASTROINTESTINAL BLEEDING

RESUSCITATION

AIRWAY

CIRCULATION

EVALUATE CAUSE

CAUSE/LESION CLINICAL FEATURES
Peptic Ulcer History of NSAIDS, steroids, smoking, alcohol
Gastric erosions History of NSAIDS, steroids, smoking, alcohol
Gastritis/Oesophagitis/Duodenitis History of NSAIDS, steroids, smoking, alcohol
Varices History of chronic liver failure, alcohol abuse
Stimata of chronic liver disease
Mallory-Weiss Tear History of vomiting/dry retching prior to haematemsis
Aorto-enteric aneurysm History of AAA repair

DETERMINE SEVERITY

Indications of significant bleed

FURTHER INVESTIGATIONS

DEFINITIVE MANAGEMENT

IV Ranitidine/IV Omeprazole (no evidence this reduces the rebleed rate, transfusion requirement or length of hospitalisation)

Octreotide

Indications

Dose

Sengstaken-Blakemore Tube

Indications

Acute endoscopic intervention

Indications

Intervention

Surgical

Indications

Interventions

Other interventions

DISPOSAL

Discharge if:

Followup

Admit to HDU/ICU if:

Admit all others to ward

PROGNOSIS

By Clinical features

Good

Bad

By endoscopic findings/causative lesion

LESION ACUTE REBLEEDING RATE SURGICAL RATE MORTALITY
Peptic ulcer 10-30% (GU>DU) 2-60% 5%
Erosions 5% 5-10% 5-10%
Varices 40-70% 15-16% 20-30%
Mallory-Weiss Tear 10-15% 5-15% <5%

By endoscopic finding in peptic ulcers

ENDOSCOPY FINDING REBLEED RATE
Active bleeding 85-90%
Vessel on view 35-50%
Clots 30-40%
Flat spot 5-10%
None < 5%