It is characterized as a potentially fatal emergency and requires immediate hospitalization. It is defined as a loss of serious blood with various causes.
In the case of upper gastrointestinal bleeding, it is derived from a source proximal to the ligament of Treitz.
Signs and symptoms
High Digestive Hemorrhage presents the following symptoms:
- Epigastric pain.
- Diffuse abdominal pain.
- Dysphagia .
- Decompensation of the body.
- Nervous sweating
- General discomfort.
Peptic ulcer disease remains the most common cause of High Digestive Hemorrhage.
In a literature review involving more than 10,000 patients with High Digestive Hemorrhage, the peptic ulcer was responsible for 27-40% of all bleeding episodes.
A peptic ulcer is strongly associated with Helicobacter pylori infection.
The organism causes the alteration of the mucosal barrier. It directly affects the gastric and duodenal mucosa, reducing the mucosa defenses and increasing the diffusion of acid after loosening the narrow cell junctions.
Duodenal ulcers are more common than gastric ulcers, but the incidence of bleeding is identical for both.
In most cases, bleeding is caused by erosion of an artery at the base of the ulcer. In approximately 80% of patients, bleeding from a peptic ulcer stops spontaneously.
A minority of patients experience recurrent bleeding after endoscopic treatment, and these cases are usually associated with risk factors for rebleeding.
These factors include age over 60 years, the presence of shock on admission, coagulopathy, active pulsatile bleeding, and the presence of cardiovascular disease.
Other causes of High Digestive Hemorrhage:
Patients with chronic liver disease and hypertension have an increased risk of bleeding or ulcerative hemorrhage.
The rare causes of upper gastrointestinal bleeding include gastric antral vascular ectasia, aortoenteric fistula, Osler-Weber-Rendu syndrome, and telangiectasia.
To determine if the affected person suffers from a High Digestive Hemorrhage, the attending physician must perform the following studies:
- Complete blood count with differential.
- Basic metabolic profile, blood urea nitrogen, and coagulation profile.
- Level of hemoglobin.
- Level Gastrin .
- Calcium level
- Nasogastric washing.
- Chest x-ray.
- Angiography (if the bleeding persists and the endoscopy does not identify a bleeding site).
The treating physician must identify the causes of the bleeding to determine the treatment; for this, the first thing to do is the following:
- Replace each milliliter of blood loss with 3 ml of crystalloid fluid.
- In patients with severe medical conditions that coexist, a catheter should be placed in the pulmonary artery to control the cardiac hemodynamic output.
- Placement of the Foley catheter for continuous assessment of urinary output as a guide for renal perfusion.
- Endoscopic hemostatic therapy for bleeding ulcers and varicose veins.
- Surgical repair of the perforated viscus.
- High doses of intravenous proton pump inhibitors for patients with high-risk peptic ulcers.
The indications for surgery in patients with Upper Digestive Hemorrhage should have a perforation, obstruction, malignancy, or also:
- Severe and life-threatening bleeding that does not respond to resuscitation efforts.
- Failure of medical therapy and endoscopic hemostasis with persistent, recurrent bleeding.
- Prolonged bleeding, with 50% or more blood volume loss.
- A second hospitalization for bleeding due to a peptic ulcer.
The incidence of Upper Digestive Hemorrhage is approximately 100 cases per 100,000 inhabitants per year.
Bleeding from the upper gastrointestinal tract is approximately four times more common than bleeding from the lower gastrointestinal tract and is a significant cause of morbidity and mortality.
The mortality rates of High Digestive Hemorrhage are 6-10% in general.
In patients with High Digestive Hemorrhage, it has been observed in 50.9% of patients, with similar occurrences in men (48.7%) and women (55.4%).