title: Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy.
abstract: Acute upper gastrointestinal bleeding is a relatively common, potentially life-threatening medical emergency responsible for more than 300,000 hospital admissions and about 30,000 deaths per annum in America. The initial assessment focuses on bleeding activity, bleeding severity, hemodynamic compromise from the bleeding, and differentiating upper from lower gastrointestinal bleeding. The initial supportive therapy includes fluid resuscitation to reverse the hypovolemia, blood transfusions to replete the lost blood, respiratory support as necessary, and proton pump inhibitor therapy to stabilize mucosal blood clots and promote hemostasis. Esophagogastroduodenoscopy is the best test to determine the bleeding site and cause.
authors.affiliation: Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA. mscappell@yahoo.com
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cappell
authors.forename: David
authors.initials: D
authors.lastname: Friedel
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D001803:Blood Transfusion; D019411:Clinical Laboratory Techniques; D003657:Decision Making; D016099:Endoscopy, Gastrointestinal; D005440:Fluid Therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012017:Referral and Consultation; D013396:Suction; D014218:Triage
chemical_list: D054328:Proton Pump Inhibitors