UMEM Educational Pearls

Category: Critical Care

Title: Severe UGIB

Posted: 5/29/2012 by Mike Winters, MBA, MD (Updated: 6/24/2024)
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Severe UGIB

  • Differentiating between upper and lower GIB can be challenging. 
  • A recent review evaluated the accuracy of historical features, symptoms, signs, and lab values in distinguishing between UGIB and LGIB. 
  • Features with the highest likelihood for identifying UGIB included:
    • Melenic stool on exam (LR 25)
    • A prior history of UGIB (LR 6.2)
    • Serum urea:creatinine ratio > 30 (LR 7.5)
  • Features that increased the likelihood of severe UGIB (defined as requiring blood transfusion, need for urgent endoscopy, surgery, or interventional radiology) included:
    • Heart rate > 100 bpm (LR 4.9)
    • Hemoglobin < 8 g/dL (LR 6.2)
    • History of cirrhosis or cancer (LR 3.7)
  • For patients with an UGIB, the Blatchford Score can be used to determine the need for urgent intervention.  Those with a Blatchford Score of 0 have a low likelihood for severe UGIB and may not need emergent intervention.

References

Srygley FD, et al. Does this patient have a severe upper gastrointestinal bleed? JAMA 2012;307:1072-9.