Upper gastrointestinal bleeding

May be preferred in patients whose risk of hospital-acquired pneumonia (HAP) is greater than upper gastrointestinal bleed. Data suggests a lower incidence of HAP when compared with H2-receptor antagonist... 

Management of Acute Nonvariceal Upper Gastrointestinal Bleeding"... 

Replace with 8-10 g albumin/L of ascitic fluid removed o Avoid large-volume paracentesis in patients with pre-existing hemodynamic compromise, acute renal insufficiency, active infection, or active upper gastrointestinal bleed. Cautious large-volume paracentesis in patients with tense... 

Previous peptic ulcer disease or upper gastrointestinal bleeding Cardiovascular disease and other comorbid conditions Multiple NSAID use (e.g., low-dose aspirin in conjunction with another NSAID)... 

Lewis, S.C., Langman, M.J.S., Laporte, J.R., Matthews, J.N.S., Rawlins, M.D., and Wiholm, B.E., Dose-response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding a meta-analysis based on individual patient data, Br. ]. Clin. Pharmacol., 54, 320, 2002. 

Daneshmend TK, Hawkey Q, Langman MJS, et al. Omeprazole versus placebo for acute upper gastrointestinal bleeding randomised double blind controlled trial. BMJ 1992 304 143-7. 

Lewis SC, Langman MJ, Laporte J-R, Matthews JN, Rawlins MD, Wihohn BE. Dose-response relationships between individual nonsteroidal antiinflammatory drugs and serious upper gastrointestinal bleeding. Brit J Chn Pharm 2002 54 320-6. 

The incidence of upper gastrointestinal bleeding in over-the-counter use is low but still double that of over-the-counter ibuprofen (perhaps due to a dose effect). Rare cases of allergic pneumonitis, leukocytoclastic vasculitis, and pseudoporphyria as well as the common NSAID-associated adverse effects have been noted. 

Portal hypertension most commonly occurs as a consequence of chronic liver disease. Portal hypertension Is caused by Increased blood flow within the portal venous system and increased resistance to portal flow within the liver. Splanchnic blood flow is increased in patients with cirrhosis due to low arteriolar resistance that is mediated by increased circulating vasodilators and decreased vascular sensitivity to vasoconstrictors. Intrahepatic vascular resistance is increased in cirrhosis due to fixed fibrosis within the spaces of Disse and hepatic veins as well as reversible vasoconstriction of hepatic sinusoids and venules. Among the consequences of portal hypertension are ascites, hepatic encephalopathy, and the development of portosystemic collaterals—especially gastric or esophageal varices. Varices can rupture, leading to massive upper gastrointestinal bleeding. 

Burroughs AK, Planas R, Svoboda P. Optimizing emergency care of upper gastrointestinal bleeding in cirrhotic patients. Scand J Gastroenterol Suppl 1998 226 14-24. 

Garcia Rodriguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994 343 769-772. 

Levy M Aspirin use in patients widi major upper gastrointestinal bleeding and peptic ulcer disease. New Eng. J. Med. 222 1158, 1974... 

Upper gastrointestinal bleeding may be either chronic or acute. It becomes manifest as severe or slight haemorrhages of arterial, venous or capillary origin, (s. tab. 19.3) Elimination of the blood is effected by vomiting or in the stool. 

Tab. 19.4 Causes of upper gastrointestinal bleeding (with some references and frequencies)...

Diagnostic goals The diagnostic procedure for upper gastrointestinal bleeding is largely standardized and has three main aims ... 

Tab. 19.5 Significant negative prognostic risk factors in upper gastrointestinal bleeding...

A possible spontaneous haemostasis, which is found without active therapy in about half the cases of upper gastrointestinal bleeding, should on no account encourage the assumption of a passive approach with the postponement of suitable therapeutic procedures. There is an enormous danger of massive renewed haemorrhage as well as of the development of complications within a few hours following spontaneous haemostasis, (s. fig. 19.12)... 

---