Estimating the bleeding amount in upper gastrointestinal bleeding

Written by Zhu Dan Hua
Gastroenterology
Updated on January 08, 2025
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Upper gastrointestinal bleeding is relatively common in clinical practice, generally manifesting as vomiting blood or defecating blood; typically, the amount of blood vomited is larger while the quantity of blood in stool is less. It can generally be assessed by the following indicators: First, the situation of vomiting blood and blood in stool; second, the change in hemoglobin; third, the change in blood pressure. It is generally believed that if there is a problem with blood pressure, such as low blood pressure, the bleeding is usually significant. Second, by measuring the change in hemoglobin, it is generally considered that a decrease of 10g/L in hemoglobin corresponds to an estimated blood loss of around 400ml; of course, clinically, mild to moderate anemia is especially common. The appearance of vomited blood, generally considered to be more than 250ml, can be accompanied by vomiting and melena, which are commonly seen clinically, whether the bleeding is from the upper or lower gastrointestinal tract.

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Written by Zhu Dan Hua
Gastroenterology
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Emergency measures for upper gastrointestinal bleeding

The treatment of upper gastrointestinal bleeding temporarily focuses on fasting and symptomatic fluid replacement. If the patient exhibits significant anemia, actively transfusing red blood cells to correct the anemia is advised. It is recommended that the patient rests in bed, with heart monitoring, blood pressure, and pulse being monitored. As for medications, acid-suppressing, stomach-protecting, and hemostatic drugs may initially be chosen for observation. Once the vital signs and condition have stabilized, it is important to promptly complete routine blood tests, electrocardiograms, and gastroscopy. Among these, gastroscopy is the most crucial diagnostic method, as it can clarify the cause and nature of the bleeding, such as gastric ulcer bleeding, gastric cancer bleeding, etc. Treatment plans vary depending on the cause; if the bleeding is suspected to be due to peptic ulcer disease, medication support is generally the first choice. If the bleeding is suspected to be from malignant transformation of gastric cancer, surgical intervention is typically necessary.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Common Causes of Upper Gastrointestinal Bleeding

The common causes of upper gastrointestinal bleeding mainly include the following points: First, esophageal diseases, such as esophagitis, Mallory-Weiss syndrome. Secondly, peptic ulcers, gastric cancer, acute erosive hemorrhagic gastritis, and then esophageal gastric variceal rupture caused by portal hypertension. There are also diseases of neighboring organs or tissues of the upper digestive tract, such as biliary bleeding, pancreatic diseases involving the duodenum, such as pancreatic cancer, acute pancreatitis complicated by abscess rupture and bleeding. Additionally, there are systemic diseases, such as allergic purpura, hemophilia, leukemia, etc.

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Written by Wu Hai Wu
Gastroenterology
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How to determine if upper gastrointestinal bleeding has led to hemorrhagic shock

Patients with upper gastrointestinal bleeding who experience symptoms such as cold sweats, fainting, reduced urine output, dry mouth, etc., may be experiencing hemorrhagic shock and should promptly visit the gastroenterology department or emergency department of a formal hospital for timely emergency treatment. Measures include establishing an intravenous line and actively rehydrating to replenish lost fluids and blood volume. Additionally, if the patient's condition permits, it is crucial to perform a thorough gastroscopy to ascertain the cause and location of the bleeding. When necessary, endoscopic hemostasis can be carried out. Patients with upper gastrointestinal bleeding also need treatments such as acid suppression and protection of the gastric mucosa.

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Written by Wang Li Bing
Intensive Care Medicine Department
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What medication is used for upper gastrointestinal bleeding?

Upper gastrointestinal massive bleeding is generally a medical emergency with rapid changes that can even be life-threatening. Immediate anti-shock treatment and rapid blood volume replenishment are necessary. When massive gastrointestinal bleeding occurs, the patient should be kept in a recumbent position for rest, ensuring that the airway remains clear to avoid choking during vomiting, and fasting should be maintained during the bleeding period. In clinical practice, medical treatment mainly includes the following points: firstly, actively preparing blood transfusions to replenish blood volume. Secondly, vasopressin can be used for pharmacological hemostasis. Additionally, treatments with somatostatin and octreotide are also options. Hemostasis can also be achieved through endoscopic treatment. If conservative medical treatment is ineffective, surgical treatment may be considered. (Please use medications under the guidance of a doctor.)

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Written by Jiang Guo Ming
Gastroenterology
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Is upper gastrointestinal bleeding easy to treat?

I can only say that most upper gastrointestinal bleeding can be treated. Common issues such as gastric and duodenal ulcers, complex ulcers, and bleeding caused by acute gastric mucosal lesions can be managed with intravenous or oral administration of proton pump inhibitors, such as omeprazole, lansoprazole, etc., combined with hemostatic drugs and dietary control, often achieving satisfactory therapeutic effects. Cases like bleeding from esophagogastric varices due to liver cirrhosis may require endoscopic sclerotherapy or banding, and sometimes surgery, but recurrent bleeding can occur. Bleeding caused by gastrointestinal tumors requires treatment of the primary disease and often has a poor prognosis. Additionally, bleeding from the gastroduodenal artery, which is severe and urgent, can be addressed with surgical intervention if treatments like endoscopic electrocoagulation are ineffective.