Symptoms - hematemesis (proximal to Ligament of Treitz), coffee ground emesis, melena (need 60-100 mls of blood in gut for 6-8 hours); DDx- PUD (duodenal ulcer, gastric ulcer), Gastritis (erosive, stress), Esophageal Varices, Mallory Weiss Tears, Esophagitis, Duodenitis, Aortoenteric Fistula (previous AAA operation, graft erosion into the duodenum)
DDx - PUD (duodenal ulcer, gastric ulcer), Gastritis (erosive, stress), Esophageal Varices, Mallory Weiss Tears, Esophagitis, Duodenitis, Aortoenteric Fistula (previous AAA operation, graft erosion into the duodenum)
Management - Maintain ABCs, Supplemental O2, IV access (2 large bore IVs - NS), Labs -(CBC, platelets, Chem -7, LFTs, Ca, PT, PTT, Type and Cross for 6 units PRBCs for active GI bleed, EKG, ABG prn); Insert large NG tube for gastric lavage; Consider ICU transfer; Foley catheter (maintain adequate U/O - 30-50 cc/hr), consider CVP or SG, Blood Products prn (PRBCs, platelets, FFP, cryoprecipitate). IV H2 blockers (Ranitidine 50 mg IV q 8 hrs, Cimetidine 300 mg IV q 6 hrs...). Avoid hypotension. Needs GI Consult and STAT UGI endoscopy.
Work-Up - UGI Endoscopy Nuclear Medicine Bleeding Scan, Angiography with ?embolization, OR intervention.
Note - With bleeding esophageal varices consider Vasopressin Infusion, endoscopic sclerotherapy, variceal tamponade with a Sengstaken Blakemore tube, and/or possible surgical intervention