UPPER GASTROINTESTINAL BLEEDING

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1. Brief description of the disease

2. Etiology/Cause
3. Clinical manifestations
4. Diagnostic Procedures
5. Risk Factors (Modifiable/Non-modifiable)
6. Pathophysiology
7. Nursing Management

8. Surgical Management

Interventions
 Around 80% will stop bleeding without intervention.
 EGD and colonoscopy
o Injection of epinephrine around bleeding point 
o Thermal hemostasis (electrocoagulation)
o Endoclips
 Angiography 
o Vasoconstriction via vasopressin 
o Embolization
 o Procedure runs the risk of bowel ischemia or infarction.
 Balloon tamponade
o Used for esophageal varices
o Tube is inserted into the esophagus, and balloon is inflated.
o Provides short-term hemostasis until definitive treatment can be arranged.
 Surgery 
o Considered when bleeding cannot be contained through the
above interventions (rare)
o Localization of the source is important before pursuing surgery.

Special considerations
 Patients with cirrhosis and variceal bleeding should have antibiotic prophylaxis to
prevent spontaneous bacterial peritonitis.
 Reverse any anticoagulation.
 Hold antihypertensive medications.

9. Medical Management

Medications
 Proton pump inhibitors (pantoprazole)
 Octreotide 
o Somatostatin analog, which causes splanchnic vasoconstriction
o Used for esophageal bleeding

10. Prevention