Upper Gastrointestinal Tract - How To Administer It?

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in the stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Esophageal causes (gastrorrhagia):

• Esophageal varices
• Esophagitis
• Esophageal cancer
• Esophageal ulcers
• Mallory-Weiss tear

Gastric causes: 

• Gastric ulcer
• Gastric cancer
• Gastritis
• Gastric varices
• Gastric antral vascular ectasia

Dieulafoy's lesions

• Duodenal causes
• Duodenal ulcer
• Vascular malformation, including aorto-enteric fistulae
• Hematobilia or bleeding from the biliary tree
• Hemosuccus pancreaticus or bleeding from the pancreatic duct
• Severe superior mesenteric artery syndrome

The signs and symptoms of upper gastrointestinal bleeding are as follows:

• Hematemesis - Vomiting of blood
• Melena - Blood in the stool
• Hematochezia - Passage of fresh blood through the anus, usually in or with stools
• Syncope - Loss of consciousness (fainting)
• Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
• Dyspepsia – IndigestionEpigastric painHeartburnDiffuse abdominal pain
• Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discoloration of the skin, mucous membranes, and sclera

The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

• Orthostatic blood pressure
• Complete blood count with differential counts
• Hemoglobin level
• Type and crossmatch blood
• Basic metabolic profile, BUN,
• Coagulation profile
• Serum calcium
• Serum gastrin
• Endoscopy
• Chest radiography
• Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)

Upper gastrointestinal bleeding can be managed in the following ways:

• Airway management and fluid resuscitation using either intravenous fluids and or blood
• Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
• Surgical intervention
• Treating the consequences (like anemia) that the bleeding may have caused
• Precautions are taken to prevent rebleeding