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Initial evaluation of upper GI bleeding should estimate the duration of hematemesis (vomiting bright red blood or coffee ground material), and volume of bleeding. A history of bleeding occurred after forceful vomiting (Mallory-Weiss Syndrome) should be sought.
Abdominal pain, melena, hematochezia (bright red blood per rectum), history of peptic ulcer, or cirrhosis prior bleeding episodes may be present.
Precipitating Factors. Use of aspirin, nonsteroidal anti-inflammatory agents, or anticoagulants should be sought.
Physical Exam
General: Pallor and shallow rapid respirations may be present; tachycardia indicates a
10% blood volume loss; postural hypotension, with an increase in pulse of 20 and a
decrease in systolic of 20, indicates a 20-30% loss.
Skin:
Delayed capillary refill, stigmata of liver disease (jaundice, spider angiomas, parotid
gland hypertrophy) should be sought.
Chest:
Gynecomastia (cirrhosis).
Laboratory Evaluation
CBC, SMA 12, liver function tests, amylase, INR/PTT, type and cross upper gastrointestinal
bleeding, gastrointestinal bleeding, GI bleeding PRBC, FFP. CBC q6h.
Differential Diagnosis of Upper Bleeding: Peptic ulcer, gastritis, esophageal varices,
Mallory Weiss tear (gastroesophageal junction tear caused by vomiting or retching),
esophagitis, swallowed blood from epistaxis, malignancy (esophageal, gastric),
angiodysplasias, aortoenteric fistula, hematobilia.
A minimum of two 14-16 gauge IV lines should be placed. 1-2 liters.
This disorder is defined as a mucosal tear at the gastroesophageal junction, frequently
following forceful retching and vomiting.
Treatment is supportive, and the majority of patients stop bleeding spontaneously.
Endoscopic coagulation or operative suturing may rarely be necessary.