Upper and lower gastrointestinal bleeding (hematemesis, hematochezia, melena) and their treatment
1. Big picture
Gastrointestinal bleeding is a surgical emergency until proven otherwise because the patient may die from hemorrhagic shock before the exact diagnosis is known. The first exam answer is never “endoscopy” or “CT”; the first answer is:
ABCDE → resuscitate → localize bleeding → control source
The examiner wants you to know:
- Is the patient stable or unstable?
- Is the bleeding likely upper GI, lower GI, or brisk upper bleeding presenting as hematochezia?
- What is the correct sequence: resuscitation → endoscopy/CT angiography → interventional radiology → surgery?
- When is surgery indicated?
NICE recommends formal risk scoring in acute upper gastrointestinal bleeding, immediate endoscopy after resuscitation for unstable severe upper GI bleeding, and endoscopy within 24 hours for other upper GI bleeds. ([NICE][1])
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