Acute upper gastrointestinal bleeding

Le résumé fourni par la source

Acute upper gastrointestinal (GI) bleeding usually presents with haematemesis or melaena, but should be considered in any patient with unexplained hypotension or syncope, or decompensated chronic liver disease. In patients with severe upper GI bleeding, a good outcome requires vigorous resuscitation, and close collaboration with medical, endoscopic, radiological and surgical teams: it is important to involve these specialists as early as possible to discuss the management plan. Urgent endoscopy is needed for patients with shock on admission, with known varices or signs of chronic liver disease, or evidence of continued bleeding. Anticoagulant and antiplatelet therapy should be stopped/reversed, if the benefits of doing so outweigh the risks: for patients with a mechanical prosthetic heart valve, recent acute coronary syndrome or coronary stents, discuss this with a cardiologist. Patients with low-risk peptic ulcer bleeding based on clinical and endoscopic criteria (e.g. clean ulcer base) can be discharged on the same day as endoscopy.

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