Dr.Sandeep Gulati/Upper gastrointestinal (GI) bleeding ,medical emergency and management
Introduction:
Upper gastrointestinal (GI) bleeding is a medical emergency that requires prompt assessment and management. It is a common medical problem that can result from a variety of causes, including esophageal varices, peptic ulcers, and Mallory-Weiss tears. Massive upper GI bleeding can be a life-threatening condition, especially in patients with underlying liver disease, such as decompensated cirrhosis. In this blog, we will discuss the case of Mr. X, a 36-year-old male who was admitted with massive upper GI bleeding due to decompensated cirrhosis with grade 4 esophageal varices, portal hypertension, and ascites.
Case presentation:
Mr. X was brought to the emergency department with complaints of bleeding per rectum, vomiting, pain abdomen, generalized weakness, and massive hematemesis since 4-5 days. He had a known history of chronic liver disease with grade 4 esophageal varices, portal hypertension, and ascites. On examination, he was sick-looking, had pallor, a temperature of 98.6 degrees F, a pulse rate of 143 beats per minute, a blood pressure of 90/60 mmHg, a random blood sugar of 197 mg/dL, and a blood oxygen saturation of 96% on room air. His chest examination revealed bilateral crepitations, and cardiovascular examination revealed S1S2+ sounds. His abdomen was distended, and on central nervous system examination, he was conscious and oriented.
Investigations:
All relevant investigations were done, and his reports are attached. He had deranged liver functions, including a total bilirubin of 1.1, direct bilirubin of 0.4, indirect bilirubin of 1.4, prothrombin time (PT) of 19.5 seconds, and international normalized ratio (INR) of 1.58. His hemoglobin level was 6.9 g/dL, and platelet count was 65,000/cmm. He was planned for upper GI endoscopy, but his attendants gave negative consent for the procedure. Therefore, a conservative management approach was adopted.
Treatment:
Mr. X was admitted under the care of Dr. Sandeep Gulati, a gastroenterologist and endoscopist at Neo Hospital, Noida. He was immediately shifted to the ICU, and treatment was started as per standardized protocols. He received a total of 4 units of fresh frozen plasma (FFP) and 2 units of packed red blood cells (PRBCs). He was managed conservatively with medication, including intravenous proton pump inhibitors, antibiotics, and lactulose. He was also given diuretics and albumin for the management of his ascites. His blood pressure was maintained with intravenous fluids and vasopressors. His hemoglobin levels and platelet counts were monitored regularly.
Discussion:
Upper GI bleeding is a common medical problem that can result from various causes. The most common causes of upper GI bleeding include peptic ulcers, esophageal varices, and Mallory-Weiss tears. In patients with liver cirrhosis, esophageal varices are the most common cause of upper GI bleeding. Esophageal varices are dilated veins in the lower esophagus that occur due to portal hypertension, which is a consequence of liver cirrhosis. When these varices rupture, it can cause massive upper GI bleeding, which can be a life-threatening condition.
The management of upper GI bleeding depends on the underlying cause, severity of bleeding, and comorbidities of the patient. In patients with massive upper GI bleeding, immediate resuscitation with blood products and fluid replacement.