Bleeding from Upper GI Tract

Haemorrhage originating proximal to the ligament of Treitz, typically presenting as haematemesis (vomiting blood) or melaena (black, tarry stools).

• Peptic ulcer disease: Gastric or duodenal ulcers due to NSAIDs or H. pylori.

• Variceal bleeding: Secondary to portal hypertension, often due to cirrhosis.

• Gastritis or duodenitis.

• Mallory-Weiss tear: Tear at the gastro-oesophageal junction.

• Gastric erosions.

• Gastric cancer.

• Dieulafoy’s lesion: Abnormal large artery that erodes the stomach wall.

• History & Examination: Assess severity, possible aetiology, and signs of shock.

• Lab tests: Full blood count, coagulation profile, renal function, liver function tests.

• Oesophagogastroduodenoscopy (OGD): First-line, allows direct visualisation and potential therapeutic intervention.

• CT Angiography: In cases where OGD can’t localise bleeding.

• Resuscitation: IV fluids, blood transfusion, correct coagulopathy, and monitor vitals.

• For peptic ulcer bleeding uncontrolled by endoscopy:

• • Oversew of bleeding ulcer.
  • Vagotomy and antrectomy for recurrent or large ulcers.

• For variceal bleeding:

• • Band ligation or sclerotherapy during OGD.
  • Transjugular intrahepatic portosystemic shunt (TIPS) if recurrent.
  • Surgical portosystemic shunts or oesophageal transection in select cases.

• Preoperative Localisation: Ideally via OGD, or CT angiography if required.

• Approach: Laparoscopic or open based on patient stability, surgeon expertise, and suspected pathology.

• Monitor vital signs and haemoglobin levels.

• Ensure adequate pain relief.

• Proton pump inhibitors for ulcer disease.

• Early mobilisation to prevent thromboembolic events.

• Consider prophylactic antibiotics depending on procedure performed.

• Resuscitation and stabilisation are paramount in upper GI bleed.

• OGD is essential for diagnosis, and often for treatment, of upper GI bleeds.

• Surgical intervention is reserved for cases uncontrolled by endoscopic means or for certain specific pathologies.