This document provides an outline of a lecture on upper gastrointestinal tract bleeding. It begins with definitions and discusses the epidemiology, causes, clinical presentation, diagnosis, treatment, complications, and prognosis of upper GI bleeding. The most common causes are bleeding peptic ulcers, erosive gastritis/esophagitis, and variceal bleeding from liver cirrhosis. The clinical presentation depends on features of blood loss and the underlying cause. Diagnosis involves history, physical exam, and investigations like blood tests, abdominal ultrasound, and upper endoscopy. Treatment involves resuscitation, transfusions, medications, and procedures depending on the identified cause. Complications can be from blood loss, treatment, or the underlying condition. Pro

2. Lecture outline
 Definition
 Epidemiology
 Causes
 Clinical presentation
 Diagnosis
 Treatment
 Complications
 Prognosis

3. Definition
 Upper GIT bleeding can be defined as bleeding
occuring from the gastrointestinal tract from any point
proximal to the duodeno-jejunal (DJ) flexure at the
ligament of Trietz.

4. Epidemiology
 Cases of Upper GIT bleeding have been reported
globally.
 Incidence varies from region to region and depends on
the predominant aetiology.
 Male and female affected.
 Gender disparity also hinges on aetiology.

5. Causes of upper GIT bleeding
Causes Prevalence (%)
Bleeding peptic ulcer disease
Erosive Gastritis/oesophagitis
Variceal bleeding (Liver cirrhosis)
Mallory-Weiss tear
Upper GIT tumour
(Oesophageal,gastric,duodenal)
Inflammatory bowel diseases-Crohn’s, UC
Vascular abnormalities-
Angiodysplasia,Gastric atral vascular ectasia
Stress Ulcer- following ay severe illness.
35-50
15-20
15-20
5
2
2
1

6. Clinical presentation
 Features of blood loss
 Hematemesis-fresh blood or coffee grounds
 Malena
 Hematochizia
 Pallor

7. Clinical presentation
 Features of underlying cause
 Liver cirrhosis-ascites,jaundice,wasting,parotid
fullness etc

8. Clinical presentation
 Features of haemodynamic instability (occurs in
the setting of severe blood loss)
 Hypotension
 Tachycardia
 Bradycardia
 Anaemic heart failure

9. Diagnosis
 Diagnosis is based on History,PE and investigations.
 Establishing aetiology usually secondary to patient
resuscitation.
 Initial management and resuscitation is preemient in
patients with severe upper GIT bleeding.

10. History
History of blood loss-
Hematemesis(fresh blood or coffee
groud),Malena,Haematochizia
History to ascertain haemodynamic instability-
amount of blood loss (volume, clots,
frequency),postural dizziness, fatique, lack of urine,
altered conscious level.

11. History
 History to ascertain aetiology
 Peptic ulcer disease
 Drug intake-Aspirin,NSAIDs,Steroids
 Alcohol int-
 Mallory Weiss syn- hx of protracted vomitting
 Liver cirrhosis- Hx of previous jaundice,blood
trasfusion,liver disease.

12. Examination
 Ascertain the extent of blood loss-
Pallor,hypotesion,tachycardia,bradycardia.
 Look out for possible aetiology,eg- stigmata of chronic
liver disease.
 Dont forget to do a rectal examination!

13. Investigations
 Urgent Blood grouping and cross matching- The 1st
and unarguably the most important.
 FBC + Diff
Anaemia-becomes evident after resuscitation. If
anaemic at presentation-suggests massive bled.
WBC- increased WBC sugggestive of sepsis as a possible
aetiology.
Platelets- reduced counts may be indicative of
hypersplenism due to liver cirrhosis.
Clotting profile- usually deranged In liver cirrhosis

14. Investigations contd
 Abdominal ultrasound-may reveal cirrhotic liver,
intra-abdominal mass lesion.
 Upper GI endoscopy-gold standard investigation.
Should be done within 6 hours of presentation in high
risk pts and within 24 hours In low risk patients.
Endoscopy helps to answer 4 questions viz: 1. site of
bleeding,2. activity of bleeders, 3.cause of bleeding, 4.
suitability for endoscopic management.
 Liver function test
 Renal function test
 Septic work up

15. Treatment- Stratify all patients
High risk patient Low risk patient
*Age >60 years
*Presence of shock-
SBP<100,HR>100,postural
hypotension
*Hb < 10g/dl
*Severe intercurrent illness-
Liver,cardiac,renal ,respiratory
disease or suspected variceal
bleeding.
*Age < 60 years
*No evidence of
Hypovolaemia
*Hb> 10g/L
*No underlying illness

16. Supportive treatment
 Admit patient in High dependency Unit or ICU
 ABC of life.
 A-Ensure airway is patent ,remove artificial dentures
and other foreign bodies,lie patient of the lateral side
to forestall aspiration.
 B-Ensure patient is breathing freely. If not,support
respiration.
 Circulation-Transfuse patients with severe
anaemia,those with hypotension and those with active
(on –going) bleeding.

17. Definitive treatment
 Dependent of the cause of upper GIT bleeding.
 In cases of erosive gastritis- withdraw offending
agents-NSAIDs, Alcohol, Herbal medications.
 Bleeding PUD-give IV Omeprazole 80mg stat,then
8mg hourly for 48-72 hours.
 Variceal bleeding- give vasopressin, terlipressin or
octreotide, lower portal pressure after
resuscitation,endoscopic injection sclerotherapy or
banding,balloon tamponade.
 Stress Ulcer – Give PPIs
 Mallory Weiss syndrome-give PPI,antiemetics.

18. Complications of upper GIT
bleeding
Complications of bleeding
 Severe anaemia with anaemic heart failure
 Acute kidney injury/failure
 Aspiration syndrome
 Hepatic encephalopathy
Complications of treatment
 Blood transfusion reactions
 Endoscopy complications.

19. Prognostic factors-Rockall score
Cliical Variable Point score
0 1 2 3
Age (years)
Shock
Comorbidity
Cause
Stigmata of
recent bleeding
Total
score<3=Good
prognosis.
60
No shock
Nil
MW syndrome
None or dark
spot
60-79
HR>100,SBP
>100
All other
>80
HR>100,SBP
<100
Cardiac.
GIT malignancy
Blood in the
upper
GIT,adherent
clot,spurter.
Liver,Renal,mali
gnancy.
Total score >8,
High risk of
death.

20. Thank you