Management of Upper Gastrointestinal Hemorrhage
Upper gastrointestinal hemorrhage is clinically significant to surgeons and requires a coordinated team approach with a step-wise progression. The typical presentation is usually hematemesis, melena, and occasionally hematochezia in rapid bleeds. The first priority is to provide the patient with close hemodynamic monitoring and adequate resuscitation. Once the patient has been resuscitated, the next step is upper endoscopy. If a source is identified, it is treated as appropriate. Rebleeding requires repeat endoscopy, followed by surgery for failures. If no source is identified, red blood cell (RBC) scan and angiography can be used for additional workup. Surgery is reserved for unstable patients with bleeding not controlled with any other modality.