Focused Assessment in Acute Upper GI Bleeding
| History | |
|---|---|
| Has there been haematemesis, melaena or both? Did vomiting precede the first haematemesis (suggesting Mallory-Weiss tear, although this history is absent in 50% of cases)? Was bleeding associated with syncope? | |
| Has there been previous upper gastrointestinal bleeding? What was the cause? | |
| Current and recent drug therapy: ask specifically about non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, clopidogrel, warfarin and direct-acting oral anticoagulants (fondaparinux, rivaroxaban, apixaban, dabigatran) | |
| Usual and recent alcohol intake | |
| Known chronic liver disease | |
| Other medical problems, for example heart disease, chronic kidney disease, haematological conditions. | |
| Examination | |
| Estimate the volume of blood loss from the physiological observations: | |
| Major bleed (>1500 mL; >30% of blood volume) | Minor bleed (≤750 mL; <15% of blood volume) |
Pulse ≥120/min Systolic BP <120 mmHg (note this is influenced by age and usual blood pressure) Cool or cold extremities Tachypnoea (respiratory rate >20/min) Abnormal mental state: agitation, confusion, reduced conscious level | Pulse <100/min Systolic BP ≥120 mmHg, with postural fall <20 from lying to sitting Normal perfusion of extremities Normal respiratory rate Normal mental state |
Signs of chronic liver disease?
Abdominal tenderness or masses?
Hepatomegaly, splenomegaly or ascites?