Upper GI bleed. Non Variceal

Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the esophagus, stomach or proximal duodenum. 

Peptic ulcers, caused by Helicobacter pylori infection or the use of NSAIDs and low-dose aspirin (LDA), are the most common cause.

Non-variceal upper gastrointestinal bleeding (UGIB) is still accompanied by a significant mortality rate in older patients. 

Causes of UGIB are ulcers, Mallory-Weiss lesions, erosions, esophagitis or angiodysplasia. 


Endoscopy offers the localization of the bleeding site as well as a variety of therapeutic measures. Patients with peptic lesions are effectively treated with proton pump inhibitors. Helicobacter pylori is a risk factor for the genesis of peptic ulcers and eradication therapy should be given if it is present

Initial workup :

·       History of Hemetemesis or Melena /Hematochezia ·       H/O NSAIDS use /Anticoagulants/antiplatelets/steroids /Peptic ulcer Examination: Hemodynamic status, vitals Look for Vascular lesions on the skin Consider variceal if : Splenomegaly /ascites /Features of CLD

Investigations

·       Hemogram, RFT, LFT INR Sugar, ECG, X-ray chest   ·       USG to rule out CLD ·       Serology: HBsAg, anti-HCV, HIV as pre-procedure Investigation   ·       Plan UGI endoscopy

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Management

Treatment may include the following: Secure the airway Insert bilateral, 16-gauge (minimum), upper extremity, peripheral intravenous lines Arrange Blood /FFP/Platelets depending upon CBC &INR Replace each milliliter of blood loss with 3 mL of crystalloid fluid Foley catheter placement for continuous evaluation of urinary output as a guide to renal perfusion Endoscopic hemostatic therapy for bleeding ulcers if SRH(Spurter,Ooze,Clot,Visible vessel ) seen on Endoscopy  Surgical repair of a perforated viscus For high-risk peptic ulcer patients, high-dose intravenous proton pump inhibitors: 80MG IV bolus followed by 20-40mg IV 6hrly for 3days or Till endoscopy  followed by 20-40mg  IV BD for  Ia/Ib/IIa/IIb and oral for IIC/III lesions  Indications for surgery in patients with bleeding peptic ulcers include the following: Severe, life-threatening hemorrhage not responsive to resuscitative efforts Failure of medical therapy and endoscopic hemostasis with persistent recurrent bleeding A coexisting reason for surgery (eg, perforation, obstruction, malignancy) Prolonged bleeding, with loss of 50% or more of the patient's blood volume A second hospitalization for peptic ulcer hemorrhage

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