Upper Gastrointestinal Bleeding: Management & Treatment

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

An upper gastrointestinal bleed is a serious condition and can be life threatening. In this lesson, we will learn about management and treatment for upper gastrointestinal bleeds.

He's Throwing Up Blood!

Bob is a 52-year-old man that works on Wall Street. His job is very stressful. He smokes a pack of cigarettes a day, drinks lots of coffee, and in the evenings he drinks several alcoholic drinks. He has always had a very driven personality and has high anxiety.

Over the last couple of weeks, he has been having some abdominal pain. He always has heartburn so that wasn't anything new, but the pain and having an upset stomach was new. This morning when he woke up, he was feeling really bad. He felt dizzy when he stood up and thought he might pass out. The abdominal pain was worse. Before he knew it, he was throwing up. But when he threw up, something alarmed him. He hadn't eaten since the night before and this wasn't like anything he'd previously thrown up. It looked like coffee grounds. His wife wisely insisted he go to the emergency room.

In the emergency room, Bob explained the symptoms that he had been having. When he told the doctor about throwing up in the morning, the doctor explained that the coffee ground appearance was typical of blood. Bob was alarmed at this news and wasn't sure what it meant. But the doctor and nurses were busy drawing blood and ordering tests, so he couldn't find out more information at that time.

What is an Upper Gastrointestinal Bleed?

Your gastrointestinal (GI) system includes many different parts that ingest and absorb food, fluid, and nutrients and then finally removes any leftovers from your body. Your GI system starts at your mouth and ends at your anus.

Gastrointestinal System
GI system

An upper gastrointestinal bleed is one that occurs in the upper portion of your GI tract, typically the stomach or esophagus. An upper GI bleed is not a disease in itself but a symptom of another condition.

Common causes of an upper GI bleed include peptic ulcers, which are sores in your stomach, or gastritis, which is an inflammation of your stomach lining. Esophageal varices are enlarged veins in the esophagus due to restricted blood flow in the liver. These can rupture and cause a GI bleed as well.

Management and Treatment

A GI bleed can be life threatening due to the blood loss. It requires emergency medical attention to manage it.

In the emergency room, the nurse starts an IV on Bob to give him fluids. His blood pressure is low and his heart rate high due to his blood loss. She also draws blood to check his levels to assess how much blood he has lost. She explains that a blood transfusion may be necessary.

Based on his symptoms and his history, the doctor tells him that he suspects an upper GI bleed in his stomach. He explains that he ordered medications called proton pump inhibitors to go through his IV to decrease the acid in his stomach to help the open sore heal. He also explains that he needs to take him for a test to look inside his stomach to locate the bleed, called an endoscopy. He tells him that he will be sedated for this test and once the bleed is found, he can repair it at the same time to stop the bleeding.

Bob's labs come back showing mildly decreased blood levels but he didn't require a blood transfusion. The IV fluids were sustaining his blood pressure adequately. He completed the endoscopy and the doctor explained that he was able to stop the bleed.

Upon discharge from the hospital, the doctor explains that Bob needs to make some lifestyle changes. He tells Bob that he had a peptic ulcer, which is often caused by high stress, caffeine use, smoking, and alcohol use. He explained that he was lucky this time and without changes, the next time he may have a more significant bleed that could risk his life. He also prescribes Bob a proton pump inhibitor, pantoprazole, to continue to take daily to help decrease the chance of future issues.

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