Created by Abed El-Rahman Sawalmeh

1. An-Najah National University
Faculty Of Nursing
Prepared By :
Abed EL-Rahaman Sawalmeh

2. Outline
• Anatomy of Digestive System
• Definition
• Introduction
• Causes
• Presentations, Lab findings and Diagnostics
• Management
• Physical examination
• Summary
Upper GI Hemorrhage

3. Anatomy of Digestive System

4. Definition
Upper Gastrointestinal (GI) Hemorrhage refers to hemorrhage in
the upper gastrointestinal tract.
The anatomic cut-off for upper GI bleeding is the ligament of
Treitz, which connects the fourth portion of the duodenum to
the diaphragm near the splenic flexure of the colon.
Upper GI bleeds are considered medical emergencies, and
require admission to hospital for urgent diagnosis and
management.
Due to advances in medications and endoscopy, upper GI
hemorrhage is now usually treated without surgery.
Upper GI Hemorrhage

5. Introduction
• Upper GI Hemorrhage is a very frequent medical
problem.
• Bleeding Peptic Ulcer, Portal hypertension,
Gastritis and Esophageal varcies are the common
causes for hemorrhage.
• Hematemesis or melena is usually present unless
rate bleeding is minimum.
• Acute bleeding stops spontaneous is 75%cases.
• Rest of the patient’s require surgery or die out of
complications.
Upper GI Hemorrhage

6. Causes
• A number of medications increase the risk of
bleeding including NSAIDs and SSRIs.
• SSRIs double the rate of upper gastrointestinal
bleeding.
• There are many causes for upper GI hemorrhage.
Causes are usually anatomically divided into their
location in the upper gastrointestinal tract.
• People are usually stratified into having either
variceal or non-variceal sources of upper GI
hemorrhage, as the two have different treatment
algorithms and prognosis.
Upper GI Hemorrhage

7. Incidence
CommonCauses
Peptic Ulcer 45%
Duodenal Ulcer
Gastric Ulcer
Esophageal varcies 20%
Gastritis 20%
Mallore-Weiss Syndrome 10%
UncommonCauses 5%
Gastric Carcinoma
Esophagitis
Pancreatitis
Upper GI Hemorrhage

8. Presentations, Lab findings and Diagnostics
Patients with upper GI hemorrhage often present
with hematemesis, melena, or hematochezia.
If the hemorrhage is severe. The presentation of
bleeding depends on the amount and location of
hemorrhage.
• Hematemesis
– Vomiting of blood is common when bleeding
originates from stomach or esophagus.
– Coffee-ground when gastric acid converts hemoglobin
into methemoglobin.
Upper GI Hemorrhage

9. Presentations, Lab findings and Diagnostics
• Melena
– Passage of black tarry stools are common when there is
bleeding from any part of Upper GIT.
– The black color of melenic stool is caused by Hematin, the
product of oxidization of Haem by intestinal and bacterial
enzymes.
• Hematochezia
– It is defined as passage of bright-red blood from the rectum.
– Common in bleeding from Colon, Rectum and Anus.
– In case of brisk bleeding in the Upper GIT, Bright red blood may
come out uncharged in the stool.
Upper GI Hemorrhage

10. Presentations, Lab findings and Diagnostics
• Patients may also present with complications of
anemia, including chest pain, syncope, fatigue and
shortness of breath.
• The physical examination performed by the physician
concentrates on the following things:
– Vital signs, in order to determine the severity of bleeding
and the timing of intervention
– Abdominal and rectal examination, in order to determine
possible causes of hemorrhage
– Assessment for portal hypertension and stigmata of
chronic liver disease in order to determine if the bleeding
is from a variceal source.
Upper GI Hemorrhage

11. Presentations, Lab findings and Diagnostics
The diagnosis of upper GI bleeding is assumed when
hematemesis is documented.
In the absence of hematemesis, an upper source for GI
bleeding is likely in the presence of at least two factors
among:
Black stool ##Age< 50 years ##BUN/Creatinine ratio 30 or more.
In the absence of these findings, consider a nasogastric
aspirate to determine the source of bleeding.
If the aspirate is positive, an upper GI bleed is greater
than 50%, but not high enough to be certain.
If the aspirate is negative, the source of a GI bleed is likely
lower.
Upper GI Hemorrhage

12. Presentations, Lab findings and Diagnostics
• In a study published regarding a new scoring system called the
Glasgow-Blatchford bleeding score in Lancet on January 3, 2009,
16% of patients presenting with upper GI bleed had GBS score of
"0", considered low.
• Among these patients there were no deaths or interventions
needed and the patients were able to be effectively treated in an
outpatient setting.
• Score is equal to "0" if the following are all present:
– Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
– Systolic blood pressure >109 mm Hg
– Pulse <100/minute
– Blood urea nitrogen level <18.2 mg/dL
– No melena or syncope
– No past or present liver disease or heart failure
Upper GI Hemorrhage

13. Management
Initial assessment and management goals:
– Assessment of the statues of the circulatory
system and replace blood loss as necessary (ABC)
– Determine the amount and rate of bleeding.
– Slow or stop the bleeding by ice-water lavage.
– Discover the lesions responsible for the episodes.
– Specific management for underlying causes.
Upper GI Hemorrhage

14. Physical examination
• The goal of the patient’s physical examination
is to evaluate for shock and blood loss.
• Signs of shock include cool extremities,
oliguria, chest pain, pre-syncope, confusion,
and delirum.
• Hematemesis and melena should be noted.
Upper GI Hemorrhage

16. Thank you !