Acute Upper Gastrointestinal Bleeding (UGIB)
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define upper gastrointestinal bleeding (UGIB) in children.
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Identify the common causes of UGIB by age group.
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Recognize clinical signs and complications of UGIB.
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Outline the appropriate investigations for UGIB.
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Implement immediate and specific treatment measures, including pharmacological therapy.
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Understand management of variceal versus non-variceal UGIB.
Description
Upper gastrointestinal bleeding is haemorrhage originating proximal to the ligament of Treitz. Presentation can vary depending on the severity and source, from mild anaemia to life-threatening shock. Rapid assessment and stabilization are critical.
Common Causes of Acute Upper GI Bleeding
| Age Group | Causes |
|---|---|
| Neonates | Haemorrhagic disease of the newborn, swallowed maternal blood, stress ulceration, coagulopathy |
| Infants (1 month – 1 year) | Oesophagitis, gastric ulceration |
| Infants (1–2 years) | Peptic ulcer disease, gastritis |
| Children >2 years | Oesophageal varices, gastric varices |
| Adolescents | Duodenal ulcers |
Signs and Symptoms
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Haematemesis (vomiting blood)
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“Coffee ground” vomitus
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Melaena (black tarry stool)
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Haematochezia (passage of fresh blood per rectum) if bleeding is severe
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Complications from anaemia or shock (tachycardia, hypotension, pallor, lethargy)
Investigations
| Category | Test / Purpose |
|---|---|
| Bloodwork | FBC, ESR, Urea & Electrolytes, Creatinine, LFTs |
| Imaging | Barium swallow / meal to detect structural lesions |
| Coagulation | Clotting profile (PT, aPTT, INR) |
| Endoscopy | Diagnostic and therapeutic (electrocautery, clipping, banding) |
Initial Management (ABCDE)
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A – Airway: Maintain airway patency; suction if necessary.
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B – Breathing: High-flow oxygen if hypoxic or in shock.
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C – Circulation: Establish IV access; fluid resuscitation with crystalloids; transfuse blood if indicated.
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D – Disability: Assess consciousness; monitor for neurological compromise due to hypovolaemia.
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E – Exposure: Assess for underlying causes, skin and mucosal findings; weigh the child.
Specific Treatment Measures
| Treatment | Dosage / Notes |
|---|---|
| Proton Pump Inhibitors (PPIs) | Omeprazole IV 0.5–2 mg/kg once daily |
| H2 Receptor Blockers | Cimetidine: Infants 10–20 mg/kg/day PO QID or IV, Children <16 yrs 20–40 mg/kg/day IV/PO QID; Ranitidine: Infants 1 mg/kg TDS, Children 12–16 yrs 150 mg BD |
| Variceal Bleeding | Octreotide: 1 µg/kg bolus IV, then 1 µg/kg/hr IV infusion; taper by 50% after 24 hr of controlled bleeding |
| Prophylaxis of Recurrent Variceal Bleed | Propranolol 10–20 mg BD; monitor for bradycardia |
| Poisoning-related Bleed | Antidotes as indicated: Desferrioxamine for iron, Vitamin K for warfarin |
⚠️ Volume replacement with crystalloids and blood products is critical; monitor for shock and coagulopathy.
Key Summary
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UGIB is bleeding above the ligament of Treitz and can be life-threatening.
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Causes vary by age: neonates often have coagulopathy or stress ulceration, infants may have gastritis or oesophagitis, older children may present with varices, and adolescents commonly have duodenal ulcers.
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Clinical signs: haematemesis, coffee-ground vomiting, melaena, haematochezia, anaemia, shock.
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Investigations: FBC, U&E, LFTs, clotting profile, endoscopy, imaging.
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Management: ABCDE, fluid/blood replacement, acid suppression, and variceal therapy if needed.