Adult Medical Emergency Handbook - Scottish Intensive Care Society

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Chapter 5
GASTROINTESTINAL EMERGENCIES
ACUTE UPPER GASTROINTESTINAL BLEEDING
• Common emergency.
• 10% mortality in the UK.
• Presentation with haematemesis and/or melaena, and with shock
or collapse.
• Syncopal symptoms such as dizziness or weakness may be
present.
AETIOLOGY FREQUENCY
• Peptic ulcer 50%
• Varices 5-10%
• Oesophagitis 10% *
• Mallory-Weiss tear 5%*
• Vascular malformation 5%*
• Gastritis 15%*
* usually respond to conservative therapy and are not life-threatening.
MANAGEMENT OF HAEMATEMESIS AND MELAENA
Standard initial assessment and management of the ill patient as
described in Chapter 2.
Immediate action for all
• Oxygen
• Secure adequate IV access.
• IV fluids: 0.9% saline or colloid.
• Avoid saline in liver disease.
• Send bloods (below) including cross-match.
• 12 lead ECG in elderly/history of cardiac disease.
• Keep NBM. Consent for endoscopy will be obtained by
endoscopist or other GI staff. Note any previous history of DU or
GU, NSAID, anticoagulants, liver disease or dyspeptic symptoms.
• Look for evidence of chronic liver disease such as jaundice or
spider naevi. If present refer to the GI Registrar and commence
resuscitation (below).
In all patients ascertain the severity of the bleed and at risk
factors: risk stratify.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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