How is upper gastrointestinal bleeding (UGIB) assessed?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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A complete blood cell (CBC) count with platelet count and differential is necessary to assess the level of blood loss in a patient with upper gastrointestinal (GI) bleeding (UGIB). Where possible, having the patient's previous results as a baseline is useful to gauge this loss. The CBC count should be checked frequently (every 4-6 h initially), depending on the severity of the bleeding, human genetic stability, and apparent rate of blood loss.

Assessing patients' calcium levels is useful in identifying individuals with hyperparathyroidism, but it is especially helpful in monitoring calcium in patients receiving multiple transfusions of citrated blood. Hypercalcemia increases acid secretion.

A gastrin level may identify the rare patient with gastrinoma as the cause of UGIB and multiple ulcers. It is important to recognize that moderately high elevations of gastrin are seen in patients taking proton pump inhibitors (PPIs).

Electrocardiography (ECG) should be considered, especially in those with underlying cardiac disease or risk factors. Close measurement of vital signs, including continuous pulse and blood pressure monitoring, is important and may alert clinicians to important changes in the patient's clinical stability. Careful and ongoing monitoring of volume resuscitation is essential to avoiding end-organ injury, especially acute myocardial infarction due to hypotension.

It is critical to use a multidisciplinary approach in patients with severe UGIB. Intensivists, primary care providers, surgeons, interventional radiologists, and cardiologists may all play an essential role, depending on the presence of patients' comorbidities and their clinical course.

See Upper Gastrointestinal Bleeding Imaging and Esophageal Varices Imaging for more information.

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