Upper GI Bleeding

Upper GI Bleeding

Upper GI Bleeding


Pathology:                   Bleeding originating proximal to the ligament of Treitz(suspensory muscle of duodenum, inserts into distal duodenum) in the GI tract.


Aetiology:                    Oesophagus: Ulceration (aspirin, NSAIDs), oesophageal varices, malignancy,


Gastric: Ulceration, adenocarcinoma,varices, angiodysplasia

Duodenum: Ulceration, varices, malignancy,angiodysplasia


Symptoms:                   Oesophageal:dysphagia, odynophagia, dyspepsia.

Gastric Ulcer:abdominal pain, worsens on eating

Duodenal Ulcer:  abdominal pain, improves on eating


Signs:                            Haematemesis,malaena, shock

                                         Stigmata of liver disease (Varicealbleeding): Jaundice, ascites, spider naevi, caput

                                                                                                                                     medusae, splenomegaly


Investigations:          Bloods: FBC - Anaemia, U&E showing increased urea (protein meal fromblood),

  Clotting screen and Group and Save

OGD: Locatesource of bleeding

                                          CTAngiography: Locate source of bleeding


Treatment:                  Medical: PPI, correct coagulopathy, blood transfusion

                                          OGD: Treat ulcers to stop bleeding

                                          CTAngiography: Embolisation of bleeding vessel

                                          Surgery: If refractory bleeding  


Complications:            Hypovolaemic shock, renalfailure, death


Prognosis:                     The Rockall score is used to risk stratify mortality and rebleeding risk.The pre- endoscopy score is often used to calculate risks. Score > 3 is a highrisk patient.


Table   3.1 Rockall Score


Score   0

Score   1

Score   2

Score   3


< 60


> 80



No shock

HR   > 100

SBP > 100

SBP < 100



Nil Major



major morbidity


Renal failure, liver failure, metastatic cancer






Evidence of bleeding



Blood, adherent clot, spurting vessel


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