Def. Bleeding between mouth and duodenum (proximal to the ligament of Treiz) → where endoscope can reach

Presentation

• Common: Melena, Hematemesis
• Should in considered in BRBPR / Hematochezia h + unstable presentation

Etiology

Non-variceal

• PUD - Peptic Ulcer Disease → Hx of NSAID use, H. pylori
• !Malley-Weiss Tear → Hx of Retching

Variceal

• !Variceal UGIB → Hx of (Cirrhosis, Portal Hypertension)

Other less common causes

• Gastric Cancer (Weight loss + IDA - Iron Deficient Anemia is more common presentation)

Acute Management

Principle:

1. ABCs (primary survey) (resuscitation)
   • ETT - Endotracheal Intubation to protect airway from blood
   • IV Fluid Resuscitation for !Hypovolemia ↓
   • RBC transfusion if indicated
2. Pharmacotherapy
3. Correct coagulopathy if applicable
4. Upper Endoscopy → within 12 h for sus. variceal cause, 24 h for sus. non-variceal cause
   • Confirm diagnosis
   • Determine Prognosis
   • Treatment
5. Escalation of treatment

!Non-variceal UGIB