Diagnosis

It is important to identify the cause and location of upper GI bleeding. After the patient is resuscitated, upper endoscopy is performed to allow for identification of the bleeding site. In most cases this can be successfully accomplished. In addition, therapeutic measures such as heater coagulation, epinephrine injection, and variceal banding can be performed at the same setting after diagnosis is confirmed. Before

Table 11.1. Causes of upper gastrointestinal bleeding

Source

Frequency

Peptic ulcer disease

45%

Gastritis

30%

Esophageal varices

10%

Mallory-Weiss tear

10%

Gastric carcinoma

5%

upper endoscopy can be performed, placement of a nasogastric tube can help distinguish upper GI bleeding from lower. Basically, a bleeding site proximal to the ligament of Treitz is suggested when blood is aspirated from a properly placed nasogastric tube. Angiography and tagged red blood cell scan can also help to identify the site of bleeding but are not commonly needed in cases of upper gastrointestinal hemorrhage.

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