Most GI bleeding comes from the duodenum or stomach and this area should be investigated first. Although conversion of iron in the GI tract typically results in tarry, melanotic stools, rapid transit from a brisk bleed may not allow time for oxidation and may present bright red blood per rectum like a lower GI bleed.
Massive upper GI bleeds most commonly result from erosion into the gastroduodenal artery by a posterior penetrating duodenal ulcer (narrative on portal hypertension and bleeding esophageal varices to follow at a future date). Initial endoscopic control of a bleeding ulcer is usually achieved with bipolar coagulation and/or injection of epinephrine. However, if a vessel is visible in the base of the ulcer, the chance of re-bleed is greater than 50%.
Link to this frame from your Personal Thumbnails page?
Click the "Update" button to save your Notes and Personal Thumbnails.