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Etiology
Epidemiology
The incidence of UGIB is between 47 and 116 per 100,000
population. There are about 2,500 admissions to hospital
everyyear in the United Kingdom for UGIB. Incidence is
highest in areas of low socioeconomic status.
ȈAge over 60
ȈPresence of signs of shock at admission
ȈCoagulopathy
ȈPulsatile haemorrhage
ȈCardiovascular disease
Assessment- History
ȈAlcohol intake.
ȈPast history of bleeding (haematemesis or melaena) or of
anaemia.
ȈDrug history is important. Drugs such as NSAIDs, aspirin
and corticosteroids are an important cause of
bleeding.Iron and bismuth may mimic melaena.
ȈRetching may precede bleeding with a 'Mallory-Weiss'
tear.
Examination
Differential diagnosis
Laboratory tests
ȈFull blood count
ȈCrossmatch blood (usually between 2 and 6 units
according to rate of active bleeding)
ȈCoagulation profile:
Platelet count
Prothrombin time with activated partial thromboplastin
time and an international normalised ratio (INR)
Fibrinogen level
Note:
Imaging
ȈCXR:
Treatment:
Clinical presentation
Pathopysiology:
Usually the bacteria called Hpylori is the root cause of
ulcers, they eataway the tissues of the stomach lining where
the inflammation of gastritis hascaused a weakened area of
the tissue.
Causes
Upper GI bleeding originates in the GI tract from the
mouth to the ligament of Treitz where the duodenum, the
first part of the small intestine, ends. Bleeding from the
esophagus may occur from esophageal varices, dilation of
the veins in theesophagus. This can occur with liver
cirrhosis, because blood from the GI tract to the liver
backs up when it has difficultygetting through the liver.
For the stomach and duodenum, bleeding in these areas
can often occur from tumors and ulcers,the latter of which
can be due to certain medications (e.g., nonsteroidal anti-
inflammatory drugs) or the bacterium
Helicobacter pylori.
These causes do not comprise a complete list but do
represent common causes.