UPPER GI BLEEDING NOTES

THE GASTROINTESTINAL SYSTEM:

- Set of organs, glands and ducts that work together to transform food into nutrients for
cells.
COMPONENTS OF UPPER GI TRACT
- The upper GI tract is generally considered to be the mouth, esophagus, stomach,
and finally the first part of the small intestine (duodenum). The lower GI tract runs
from the small intestine to the large intestine (colon) to the anus.
- The upper GI tract digests your food and prepares it for processing and utilizing
nutrients throughout the body. Problems with the upper GI tract can manifest
symptoms like burping, problems swallowing, heartburn, acid reflux, upset stomach,
or abdominal pain.

WHAT IS UGIB?
- Upper gastrointestinal (GI) bleeding refers to bleeding that occurs anywhere in the
esophagus, the stomach, or the upper part of the small intestine.

Upper GI bleeds can occur in the:

● esophagus
● stomach
● duodenum, the initial part of the small intestine

HOW NSAIDS CAUSES GI BLEEDING?

- NSAIDs are second to Helicobacter pylori infection in causing peptic ulceration in the
upper GI tract. They cause mucosal injury due to cyclo-oxygenase (COX)-1 inhibition
by reduction of cytoprotective mucosal prostaglandins and reduction of the secretion
of a protective bicarbonate mucus barrier in the stomach and small bowel.

WHAT IS MALLORY WEISS TEAR?

- A Mallory-Weiss tear is a tear of the tissue of your lower esophagus. It is
most often caused by violent coughing or vomiting. A Mallory-Weiss tear can
be diagnosed and treated during an endoscopic procedure.

ESOPHAGEAL VARICES
- Esophageal varices are enlarged veins in the esophagus. They're often due
to obstructed blood flow through the portal vein, which carries blood from the
intestine, pancreas and spleen to the liver.
TERMINOLOGIES:

HEMATEMESIS - vomiting with blood

MELENA - refers to a black, tarry and sticky stool which indicates UGIB
HEMATOCHEZIA - passage of fresh, bright red colored stool indicated LGIB
(cecum, colon, rectum, anus)

*Take note: Coffee ground vomitus is an indication of internal bleeding somewhere

in your upper GI tract.

PATIENT MONITORING:
● PAP & CVP monitoring - These are done to monitor hemodynamic status of the
patient. It is essential to regularly monitor the circulatory status of the patient in order
for us to identify whether the patient is responding from fluid replacement or not.
● Central venous pressure (CVP) is measured directly by insertion of a catheter
through the anterior vena cava to the level of the right atrium.
● NORMAL CVP: 2-6 mm/Hg

PATIENT MANAGEMENT:
● COLLOIDS - has high tendency to stay intravascular (i.e., Albumin, FFP, Dextran)
● DEXTRAN - high molecular weight, a plasma volume expander made from sugar. It
works by restoring blood plasma lost through severe bleeding.Plasma is the liquid
component of your blood that contributes to 55% of your blood's total volume.
● FRESH FROZEN PLASMA - is indicated for the deficiency of coagulation factors
with abnormal coagulation tests in the presence of active bleeding.

PHARMACOLOGIC MANAGEMENT:
● PPI - Proton pump inhibitors (PPIs) are medicines that work by reducing the
amount of stomach acid made by glands in the lining of your stomach, neutralizing
gastric pH (ex: Pantoprazole). These are usually taken 30 mins before breakfast.
● SOMATOSTATIN/OCTREOTIDE - Through vasoconstriction, somatostatin
diminishes blood flow to the portal system, thus decreasing variceal bleeding.
● PROPRANOLOL - This works by decreasing the heart rate and widening the
blood vessels, it also lowers the blood pressure in varices that bypass the
liver.

WHAT IS SPLANCHNIC CIRCULATION?

- describes the blood flow to the abdominal gastrointestinal organs including the
stomach, liver, spleen, pancreas, small intestine, and large intestine.
SURGICAL MANAGEMENT:
● BAND LIGATION - Endoscopic variceal ligation, or endoscopic band ligation, is
a procedure that uses elastic bands to treat enlarged veins, or varices, in
your esophagus. It is a standard procedure in the management of acute
variceal bleeding and is beneficial in the prophylaxis of variceal bleeding.
● SENGSTAKEN BLAKEMORE TUBE - Is usually inserted through your mouth,
although sometimes it can be done through your nose. Once it’s in your stomach,
your doctor will inflate the tube with some air and then take an X-ray scan to make
sure it’s in the right place. Once they make sure it's in the correct spot, they’ll inflate it
in small amounts.