Upper GI bleed
Formal Definition
Gastrointestinal hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, or proximal duodenum); manifests as hematemesis (vomiting blood or coffee-ground material) or melena (dark, tarry stools); common causes include peptic ulcer disease, esophageal varices, Mallory-Weiss tear, and Dieulafoy lesion.
How It's Used on the Ward
"Upper GI bleed" or "UGIB" — blood coming from above the ligament of Treitz, the anatomical dividing line between upper and lower GI bleeding.
Example
""62-year-old NSAID user with hematemesis and a hemoglobin drop of 4 points: active UGIB. Two large-bore IVs, type and crossmatch, IV PPI bolus, GI on call, NPO for urgent EGD. Risk-stratify with Glasgow-Blatchford score.""
Clinical Context
Resuscitation first: 2 large-bore IVs, CBC/BMP/coags/type and cross, IV fluid bolus if hemodynamically unstable. Blood products: transfuse for Hgb <7 (restrictive), or <8 in active cardiac disease. Pre-endoscopy PPI (IV bolus + infusion) reduces high-risk stigmata at scope. EGD within 24 hours (urgent EGD within 12h for hemodynamic instability or active bleeding). Variceal bleed: add octreotide (reduces portal pressure), prophylactic antibiotics (ceftriaxone), avoid over-transfusion (target Hgb 7–8, higher Hgb worsens portal hypertension). Glasgow-Blatchford or Rockford score guides inpatient vs outpatient management.
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