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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Peptic Ulcer01:27

Peptic Ulcer

Peptic ulcers are erosive lesions of the gastric or duodenal lining, most commonly caused by Helicobacter pylori infection. This Gram-negative, helical bacterium has adapted to survive the stomach’s acidic environment by producing urease, which converts urea into ammonia and carbon dioxide. The ammonia neutralizes gastric acid in the bacterium’s immediate environment, allowing colonization of the gastric mucosa. H. pylori attaches to mucus-secreting epithelial cells, penetrates the mucus...
Upper GI Series: Barium Swallow01:24

Upper GI Series: Barium Swallow

The Barium Swallow Study, or a Barium Esophagogram, is a diagnostic imaging method used to visualize the upper gastrointestinal (GI) tract, including the esophagus, stomach, and small intestine. It employs barium sulfate, a radiopaque contrast material, to provide clear images of the upper digestive system, helping to identify abnormalities, diseases, or structural issues.
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
Gastritis III: Clinical Manifestations and Management01:23

Gastritis III: Clinical Manifestations and Management

The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
Lower GI Series: Barium Enema01:23

Lower GI Series: Barium Enema

A Barium Enema, or a lower GI series, is a specialized radiographic examination designed to visualize the lower gastrointestinal tract, specifically the colon and rectum. This procedure is instrumental in diagnosing various conditions such as colorectal cancer, polyps, diverticulosis, and inflammatory bowel disease.
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The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...

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Related Experiment Video

Updated: May 24, 2026

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
04:00

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

Does this patient have a severe upper gastrointestinal bleed?

F Douglas Srygley1, Charles J Gerardo, Tony Tran

  • 1Department of Medicine, Duke University Medical Center, PO Box 3913, Durham, NC 27710, USA. srygl001@mc.duke.edu

JAMA
|March 15, 2012
PubMed
Summary

Distinguishing upper gastrointestinal bleeding (UGIB) from lower gastrointestinal bleeding (LGIB) is crucial for emergency physicians. Melena, specific NG lavage findings, and BUN:creatinine ratios help identify UGIB, while the Blatchford score aids in risk stratification.

Related Experiment Videos

Last Updated: May 24, 2026

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
04:00

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

Area of Science:

  • Gastroenterology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Accurate differentiation between acute upper gastrointestinal bleeding (UGIB) and acute lower gastrointestinal bleeding (LGIB) is essential for emergency physicians to guide appropriate diagnostic and therapeutic strategies.
  • Determining the severity of UGIB is critical for identifying patients requiring urgent intervention.

Observation:

  • A systematic review of MEDLINE and other literature identified clinical factors, bedside maneuvers, and laboratory results distinguishing UGIB from LGIB.
  • Studies included adult patients evaluated in emergency departments, focusing on methods excluding endoscopic findings in prediction models.

Findings:

  • Key indicators for UGIB include a history of melena, melenic stool, positive nasogastric lavage (blood or coffee grounds), and a serum urea nitrogen:creatinine ratio > 30.
  • Conversely, blood clots in stool decrease the likelihood of UGIB. Factors like red blood in NG lavage, tachycardia, and hemoglobin < 8 g/dL increase the likelihood of severe UGIB.
  • The Blatchford score effectively identifies patients with UGIB who are unlikely to require urgent intervention (Blatchford score of 0).

Implications:

  • Clinical assessment incorporating historical features, physical examination, and basic laboratory tests can reliably differentiate UGIB from LGIB in the emergency setting.
  • The Blatchford score provides a valuable, non-invasive tool for risk stratification of UGIB patients, optimizing resource allocation and patient management.
  • These findings support evidence-based decision-making for emergency physicians managing acute gastrointestinal bleeding.