Causes & Assessment
Causes: PUD (most common), esophageal varices, Mallory-Weiss tear, gastritis. Presentation: hematemesis, melena, coffee-ground emesis, dizziness, syncope. Hemodynamic instability: tachycardia, hypotension.
Initial Management
ABCs: secure airway (aspiration risk). Large-bore IV x2, fluid resuscitation (crystalloid then blood, Hgb >7). IV PPI (pantoprazole 80 mg bolus + 8 mg/hr). Octreotide for varices. Urgent EGD within 24h.
Ongoing Care
Monitor vital signs, hemoglobin trend (q6-12h), melena output, mental status. Avoid NSAIDs. Varices: band ligation, TIPS. Restrictive transfusion strategy. Watch for rebleeding: tachycardia, BP drop, increased melena.
Important Notes
- BUN:creatinine ratio >30 suggests upper GI bleed — digested blood increases BUN.
- Avoid NG tube in suspected esophageal varices without endoscopic guidance.
Clinical Tips
- Coffee-ground emesis = old blood; bright red hematemesis = active, rapid bleeding.
- A drop in Hgb may not appear for 6-12h — do not rely on initial Hgb alone.
Summary
Upper GI bleeding requires airway protection, large-bore IV access, fluid/blood resuscitation, PPI therapy, and urgent endoscopy.
