Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
UGIB commonly arises from peptic ulcer disease, portal hypertension, or mucosal injury. Stabilize hemodynamics, obtain type and crossmatch, and risk‑stratify (Glasgow‑Blatchford, Rockall). Identify liver disease stigmata and encephalopathy when variceal sources are possible. Early endoscopy within 24 h is diagnostic and therapeutic; correct coagulopathy guided by clinical context rather than INR alone.
Treatment Strategy & Disposition
Administer IV PPI for suspected nonvariceal bleed; give vasoactive therapy and prophylactic antibiotics if variceal hemorrhage is likely. Perform endoscopic hemostasis for high‑risk stigmata, then transition to oral PPI and H. pylori eradication if indicated. Manage anticoagulants/antiplatelets based on thrombotic risk; resume when hemostasis secured. Admit based on risk scores and comorbidities; ICU for ongoing transfusion needs or instability.
Epidemiology / Risk Factors
- Risk factors vary by condition and patient profile
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Baseline hematology | Abnormal counts | |
| BMP | Electrolytes/renal | Derangements |
Early Orders (Abbrev.)
| Medication | Typical use |
|---|---|
| Octreotide infusion | Reduce portal pressure |
| Ceftriaxone | Infection prophylaxis |
| PPI (adjunct) | Per local protocol |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Packed RBC | O₂-carrying capacity | Immediate | Transfuse to Hgb threshold | Transfusion reactions; ED use |
| Balanced crystalloids | Plasma volume expansion | Immediate | Resuscitation | Fluid overload; ED use |
| Octreotide (variceal) | Splanchnic vasoconstriction | Minutes | Acute variceal bleed | Abdominal cramps; ED use |
| PPI (IV) | H+/K+ ATPase inhibition | Hours | Non-variceal UGIB | Infection risk long-term; ED use |
| Ceftriaxone (cirrhosis) | Cephalosporin | Hours | SBP prophylaxis in variceal bleed | Allergy; ED use |
Prognosis / Complications
- Prognosis depends on severity, comorbidities, and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Avoid over-transfusion which raises portal pressure. Start VTE prophylaxis after hemostasis if appropriate and bleeding risk acceptable.