Upper GI (UGI) bleeding

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  • Causes:

Gastric ulcer Duodenal ulcer Esophageal varices Gastric varices Mallory-Weiss tear Esophagitis Neoplasm Hemorrhagic gastritis Dieulafoy lesion Angiodysplasia Hemobilia Pancreatic pseudocyst Pancreatic pseudoaneurysm Aortoenteric fistula

  • Peptic ulceration is a common cause of UGI bleeding; hemorrhage from a duodenal ulcer is four times more common than gastric ulcer bleeding and duodenal ulcers are four times more common than gastric ulcers
  • Acute lesions are found in the body and fundus; chronic ulcers are frequently found on the antrum and lesser curvature
  • Thought to be due to decreased gastric blood flow secondary to splanchnic vascoconstriction, cytokines, sepsis hypotension, renal faiure, respiratory failure, and burns
  • Symptoms and signs

Hematemesis - 40-50% Melena - 70-80% Hematochezia - 15-20% Either hematochezia or melena - 90-98% Syncope - 14.4% Presyncope - 43.2%

  • Symptoms 30 days prior to admission - No percentage available

Dyspepsia - 18% Epigastric pain - 41% Heartburn - 21% Diffuse abdominal pain - 10% Dysphagia - 5% Weight loss - 12% Jaundice - 5.2%

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