Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Upper GI Bleed

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In one line

·Bleeding from the esophagus, stomach, or the first part of the small intestine—above the ligament of Treitz (the bend where the small intestine starts)—floods the gut with blood and drops the body's total blood volume fast.

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Normal physiology

·The esophagus (swallowing tube), stomach, and duodenum (the first part of the small intestine, ending at the ligament of Treitz) are lined with a layer of mucus-secreting cells that also release bicarbonate (a base) to neutralize stomach acid and protect the tissue underneath. Just below this lining sits a rich network of blood vessels (the submucosal plexus) that supplies oxygen and nutrients to keep the tissue alive. The stomach also makes hydrochloric acid (a strong acid) in special cells called parietal cells to break down food, and pepsin (a protein-digesting enzyme) to help digest what you eat. Normally, the mucus barrier keeps the acid from burning the lining, and tiny injuries heal quickly because platelets (sticky blood cells) plug small leaks and clotting factors seal them shut.

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What goes wrong

·Something punches through, erodes, inflames, or overstretches the lining of the esophagus, stomach, or duodenum so that blood vessels underneath are exposed and start leaking blood into the gut.

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Hallmark signs

·Throwing up blood (hematemesis) — can look bright red or like coffee grounds
·Black, tarry, sticky stools (melena) that smell very bad
·Bright red blood in the stool (hematochezia) when the bleed is very fast
·Feeling dizzy, lightheaded, or fainting when standing up
·Heart racing (tachycardia) or pounding
·Pale, cool, clammy skin
·Belly pain or discomfort, especially burning in the upper stomach
·Spider-like red blood vessels on the skin (spider angiomas), swollen belly (ascites), red palms (palmar redness (erythema)), or large belly veins (caput medusae)

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Red flags · escalate now

·Throwing up bright red blood or large clots
·Feeling faint, very dizzy, or passing out
·Heart racing over 100 beats per minute at rest, or blood pressure dropping below 90 on top
·Confused, hard to wake, or very drowsy
·Bright red blood pouring from the rectum with an upper source (means massive, fast bleed)

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Workup

·Complete blood count (CBC) with hemoglobin and hematocrit
·Blood urea nitrogen (BUN) and creatinine ratio
·Prothrombin time (PT/INR) and partial thromboplastin time (PTT)
·Lactate level
·Type and crossmatch (or type and screen)
·Liver function tests (ALT, AST, bilirubin, albumin)
·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Platelet count

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Treatment

·Two large-bore IV lines (18-gauge or bigger) and start isotonic crystalloid (normal saline or lactated Ringer's) resuscitation with a restrictive transfusion strategy (target hemoglobin 7–9 g/dL in most patients, 7–8 g/dL if no heart disease)
·Intravenous proton pump inhibitor (PPI) bolus (80 mg) then continuous infusion (8 mg/hour) if non-variceal bleed is suspected (ulcer, gastritis, or erosion)
·Upper endoscopy (EGD) within 24 hours (or sooner if the patient is unstable or has high-risk features like ongoing vomiting blood (hematemesis), shock, or suspected variceal bleed)
·Octreotide bolus (50 mcg IV) then continuous infusion (50 mcg/hour) PLUS ceftriaxone (1 g IV daily) if variceal bleeding is suspected or confirmed (patient has cirrhosis signs)
·Reverse anticoagulation if the patient takes blood thinners: vitamin K (10 mg IV) for warfarin, prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP) for urgent reversal, idarucizumab for dabigatran, andexanet alfa for apixaban or rivaroxaban
·Nasogastric (NG) tube placement is NOT routine and should only be used if the diagnosis is unclear or to clear the stomach before endoscopy
·Interventional radiology (angiography with embolization) or surgery if endoscopy fails to stop the bleeding or bleeding restarts despite two tries

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NCLEX trap

·PPI is part of the plan, but it comes AFTER you place two large-bore IVs and start IV fluids in upper GI bleed. You cannot wait — the patient is losing blood volume. Make them safe first, then treat the cause.
·In variceal bleeding, you use permissive low blood pressure (hypotension) — transfuse only to hemoglobin 7 (or 8 if the patient has heart problems). Too much transfusion raises blood pressure, which pushes harder on the ruptured varices and makes bleeding worse.
·Upper GI bleed has two very different causes: non-variceal (peptic ulcer, tear, gastritis, cancer) and variceal (ruptured veins from cirrhosis). Variceal bleeding needs octreotide, antibiotics (ceftriaxone), and band ligation. Ulcer bleeding needs a scope and clips or injection. The upstream break tells you the fix.
·You stabilize the patient WITH fluids and blood, but endoscopy must happen within 24 hours — sooner if variceal or high-risk. The scope is how you find and fix the bleeding source. Delay means rebleed and higher death rate.
·Orthostasis is a symptom, not the disease. The upstream break is upper GI bleed. IV fluids buy time and stabilize the patient, but you must find the bleeding source with endoscopy and fix it — otherwise the patient will bleed again in 24–72 hours.
·Reverse anticoagulation PER the agent and bleeding severity. A patient on aspirin with a small gastritis bleed may not need reversal. A patient on warfarin (a strong blood thinner) with a ruptured varix needs urgent reversal. Match the reversal to the upstream break and the severity.

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