How to determine if upper gastrointestinal bleeding has led to hemorrhagic shock

Written by Wu Hai Wu
Gastroenterology
Updated on February 09, 2025
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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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Preferred examination method for upper gastrointestinal bleeding

Upper gastrointestinal bleeding is very common clinically. If the patient's respiratory and circulatory systems are stable, an esophagogastroduodenoscopy can be performed to further identify the bleeding site. Of course, it is also necessary to dynamically monitor blood tests and coagulation function, and pay attention to the patient's vomiting and rectal bleeding. The clinical treatment of upper gastrointestinal bleeding mainly involves transfusions to replenish blood volume and conservative medical treatment for hemostasis. If conservative medical treatment is not effective, surgical intervention can be considered.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Upper gastrointestinal bleeding includes which areas?

In clinical practice, bleeding in the digestive system above the ligament of Treitz is referred to as upper gastrointestinal bleeding. It primarily includes the following areas: The first major category is esophageal diseases, such as esophagitis, esophageal trauma, and other causes of bleeding. The second category is duodenal diseases, such as peptic ulcers, acute erosive hemorrhagic gastritis, stomach cancer, etc. Another cause is liver cirrhosis leading to portal hypertension, which can cause rupture and bleeding in esophageal and gastric varices. The fourth category includes biliary system and pancreatic diseases involving the duodenum, such as pancreatic cancer, which can also lead to bleeding.

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Written by Wang Li Bing
Intensive Care Medicine Department
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What are the characteristic manifestations of upper gastrointestinal bleeding?

The clinical manifestations of upper gastrointestinal bleeding mainly depend on the amount and speed of the patient's bleeding. Clinically, vomiting blood and black stool are characteristic manifestations of upper gastrointestinal bleeding. Secondly, if the patient has a large amount of bleeding, it can lead to a rapid decrease in circulating blood volume and subsequent peripheral circulatory failure. Patients may experience dizziness, palpitations, fatigue, and even fainting. At this point, it is crucial to actively replenish blood volume and stop the bleeding, and provide symptomatic treatment. Thirdly, blood tests can reveal signs of hemorrhagic anemia in patients. Fourthly, after gastrointestinal bleeding, patients generally develop a low fever within 24 hours, which must be actively managed.

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Written by Wang Li Bing
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Is upper gastrointestinal bleeding dangerous?

Upper gastrointestinal bleeding is life-threatening if the amount and speed of bleeding are substantial. Therefore, proactive and effective measures should be taken to rescue the patient. Generally, after anti-shock treatment and rapid blood volume replenishment, the patient's life can be saved. The main clinical treatment measures include the following: First, keep the patient in a recumbent position at rest, ensure that the airway is clear, and prevent blood aspiration due to vomiting. Second, during the bleeding period, it is necessary to enforce fasting, closely monitor the patient's vital signs, such as heartbeat, breathing, blood pressure, consciousness, etc. Third, after hospitalization, it is crucial to actively replenish blood volume, such as transfusing compatible red blood cells, plasma, cryoprecipitate, etc., for fluid expansion. Drugs like proton pump inhibitors and octreotide can be used for hemostasis. If conditions permit, a gastroscopy can be performed to stop the bleeding, and surgical treatment may be considered if necessary.

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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.