Upper Gastro Intestinal (GI) bleeding produces severe symptoms like vomiting out blood (hematemesis) or passing black tarry stools (melena). The patient’s chances of survival depend directly on the intensity of these precarious symptoms and must therefore be dealt with promptness and efficiency.

What are causes of upper GI bleeding?
Peptic ulcer disease: Peptic ulcers are localized erosions of the mucosal lining of the digestive tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, causing bleeding.
Gastritis: General inflammation of the stomach lining, which can result in bleeding. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces. Causes of gastritis include

NSAIDs or nonsteroidal anti-inflammatory drugs, for example, ibuprofen aspirin
steroids,
alcohol,
burns, and
trauma.
Esophageal varices: Swelling of the veins of the esophagus or stomach usually resulting from liver disease. Varices most commonly occur in alcoholic liver cirrhosis. When varices bleed, the bleeding can be massive, catastrophic and occur without warning.

Mallory-Weiss tear: A tear in the esophageal or stomach lining, often as a result of vomiting or retching. Mucosal tears also can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth. Physicians often find tears in people who have recently binged on alcohol.

Cancer: One of the earliest signs of esophageal or stomach cancers may be blood in the vomit or stool.
Inflammation: When the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid. NSAIDs, aspirin, alcohol, and cigarette smoking promote gastric ulcer formation. Helicobacter pylori is a type of bacteria that also promotes formation of ulcers

Initial evaluation — The initial evaluation of a patient with a suspected clinically significant acute upper GI bleed includes a history, physical examination, laboratory tests, and in some cases, nasogastric lavage.

The goal of the evaluation is to assess the severity of the bleed, identify potential sources of the bleed, and determine if there are conditions present that may affect subsequent management. The information gathered as part of the initial evaluation is used to guide decisions regarding triage, resuscitation, empiric medical therapy, and diagnostic testing.

Compiled by Dr Wrishi Raphael