eMedicine Specialties > General Surgery > Abdomen

Upper Gastrointestinal Bleeding, Surgical Treatment: Workup

Author: James de Caestecker, DO, Instructor, Department of Surgery, MCP Hahnemann University
Coauthor(s): Jason Straus, MD, Staff Physician, Department of Surgery, Wright State University School of Medicine
Contributor Information and Disclosures

Updated: Oct 6, 2009

Workup

Laboratory Studies

  • The following laboratory tests are the most useful when evaluating patients with UGIB.
    • Hemoglobin value and type and crossmatch blood: Based on the patient's initial hemoglobin level and clinical assessment of shock, a type and screen or type and crossmatch should be ordered. The patient should be crossmatched for 2-6 units based on the rate of active bleeding. The hemoglobin level should be monitored serially in order to follow the trend. An unstable hemoglobin level may signify ongoing hemorrhage requiring further intervention.
    • BUN-to-creatinine ratio: The BUN-to-creatinine ratio increases with UGIB. A ratio of greater than 36 in a patient without renal insufficiency is suggestive of UGIB.
    • Coagulation profile: The patient's prothrombin time (PT), activated partial thromboplastin time, and International Normalized Ratio (INR) should be checked to document the presence of a coagulopathy. The coagulopathy may be consumptive and associated with a thrombocytopenia.
      • A platelet count of less than 50 with active acute hemorrhage requires a platelet transfusion and fresh frozen plasma in an attempt to replete lost clotting factors.
      • The coagulopathy could be a marker for advanced liver disease.
      • The PT is used in calculating the Child-Pugh score.8 Prolongation of the PT based on an INR of more than 1.5 may indicate moderate liver impairment.
      • A fibrinogen level of less than 100 mg/dL also indicates advanced liver disease with extremely poor synthetic function.
    • Liver function tests: Liver function tests are also needed to calculate the Child-Pugh score. Elevated aminotransferase levels are a result of hepatocellular injury. Increased levels of alkaline phosphatase and gamma – glutamyl transpeptidase are indicative of cholestatic liver disease.
    • Plasma fibrinogen level
    • Serum electrolyte values
  • Patients generally require blood transfusions because of hypoperfusion and hypovolemia. Patients with significant comorbid conditions (eg, advanced cardiovascular disease) should receive blood transfusions to maintain myocardial oxygen delivery to avoid myocardial ischemia. One of the criteria used to determine the need for surgical intervention is the number of units of transfused blood required to resuscitate the patient. The more units required, the higher the mortality rate.9 Operative intervention is indicated once the blood transfusion number reaches more than 5 units, as noted in the following table.9 Table 3. Effect of Number of Packed Erythrocyte Transfusions on Need for Surgery and Mortality from UGIB

    Open table in new window

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    Table
    Number of Units TransfusedNeed for Surgery, %Mortality Rate, %
    044
    1-3614
    4-51728
    >55743
    Number of Units TransfusedNeed for Surgery, %Mortality Rate, %
    044
    1-3614
    4-51728
    >55743

More on Upper Gastrointestinal Bleeding, Surgical Treatment

Overview: Upper Gastrointestinal Bleeding, Surgical Treatment
Workup: Upper Gastrointestinal Bleeding, Surgical Treatment
Treatment: Upper Gastrointestinal Bleeding, Surgical Treatment
Follow-up: Upper Gastrointestinal Bleeding, Surgical Treatment
References
Further Reading
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Keywords

upper gastrointestinal bleeding, peptic ulcer, gastric ulcer, duodenal ulcer,  , , peptic ulcer disease, GI bleeding, gastrointestinal bleeding, esophageal varices, portal gastropathy, UGIB, aortoenteric fistula

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Contributor Information and Disclosures

Author

James de Caestecker, DO, Instructor, Department of Surgery, MCP Hahnemann University
James de Caestecker, DO is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Jason Straus, MD, Staff Physician, Department of Surgery, Wright State University School of Medicine
Jason Straus, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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