🚨 Upper GI Bleed

An Upper GI Bleed (UGIB) is bleeding originating proximal to the ligament of Treitz, commonly caused by peptic ulcers, varices, or oesophagitis. It presents as haematemesis or melaena and is a medical emergency requiring prompt assessment and management to prevent hypovolaemic shock.

Recognise UGIB by haematemesis (vomiting blood, fresh or 'coffee-ground'), melaena (tarry, black, foul-smelling stools), or signs of hypovolaemia. Patients may report epigastric pain, dyspepsia, or a history of NSAID use or liver disease. Syncope or dizziness can indicate significant blood loss.

Perform an immediate ABCDE assessment. Secure airway if GCS is low or there's active haematemesis. Assess circulation for signs of shock (tachycardia, hypotension, cool peripheries, prolonged capillary refill time). Establish large-bore intravenous access and take bloods. Assess for signs of liver disease (stigmata, ascites).

Red flags include persistent hypotension (systolic BP <90 mmHg), tachycardia (>100 bpm), GCS <12, active haematemesis, or signs of severe liver disease. Any patient with suspected variceal bleed or significant co-morbidities is at higher risk of deterioration.

Bedside: Vital signs, urine output, GCS, ECG. Bloods: FBC (Hb, platelets), U&Es, LFTs, clotting screen (INR, APTT), crossmatch (at least 2 units). Imaging: None immediately, but urgent OGD is the definitive diagnostic and therapeutic procedure.

Resuscitate with intravenous fluids (crystalloids initially) to restore circulating volume and maintain blood pressure. Transfuse blood products (red cells, platelets, fresh frozen plasma) as guided by blood loss, haemoglobin levels, and clotting. Administer a proton pump inhibitor (PPI) for non-variceal bleeds. Consider a somatostatin analogue for suspected variceal bleeds. Urgent referral for endoscopy is paramount.

Escalate immediately to a senior registrar or consultant for any signs of haemodynamic instability, active bleeding, or suspected variceal bleed. Urgent referral to gastroenterology for endoscopy is required. Consider critical care involvement for patients requiring significant resuscitation or with multi-organ dysfunction.

Rockall score and Blatchford score are used to risk stratify UGIB patients. Always consider variceal bleeding in patients with liver disease. PPIs reduce re-bleeding rates in non-variceal bleeds. Endoscopy is both diagnostic and therapeutic (e.g., clipping, banding).