Upper GI bleeding.
Haematemesis: is the vomiting of blood. Melaena is altered blood passed PR.
Common causes: peptic ulcer, gastritis, Mallory-Weiss tear, NSAIDS, steroids, thrombolytics and anticoagulants.
Others: oesophageal varices, nose bleeds, oesophageal or gastric malignancy, oesophagitis, angiodysplasia, bleeding disorders.
Treatment: bed rest, nil by mouth, 6 units of crossed matched blood, IVI 0.9% saline and blood transfusion as needed. Monitor BP, pulse, CVP, ECG and fluid balance. Do U&E, FBC, LFT, platelets, INR.
Liaise with surgeons early.
Bleeding varices. In the presence of portal hypertension, blood from the gut can reach the right heart bypassing liver via collateral veins around the oesophago-gastric junction. With pressure >12mmHg these veins dilate forming varices, which may bleed catastrophically.
Causes of portal hypertension: Presinusoidal (obstruction before the hepatic sinus): portal vein thrombosis, pancreatic tumour or pseudocyst, myelofibrosis, Hodgkin's, schistosomiasis, sarcoid. Post sinusoidal: cirrhosis, Budd-Chiari syndrome.