Emergency Measures for Massive Upper Gastrointestinal Bleeding

Massive upper gastrointestinal bleeding is a life-threatening medical emergency that requires immediate intervention. Proper and timely management can significantly improve patient outcomes. Below are the key emergency procedures used in the treatment of such cases.

Initial Stabilization and General Care

When a patient experiences severe upper gastrointestinal bleeding, the first step is to stabilize their condition. The patient should be placed in a supine position, often with the head lower than the feet to improve blood flow to the brain. If the patient is vomiting blood, their head should be turned to one side to prevent aspiration into the airway, which can lead to choking or serious lung complications. Oxygen should be administered to maintain adequate oxygen saturation. Patients should be instructed not to eat or drink anything until further medical evaluation. In cases of severe anemia or unstable vital signs, blood transfusions may be necessary to restore blood volume and oxygen-carrying capacity.

Pharmacological Treatment

Medications play a crucial role in managing upper GI bleeding. Proton pump inhibitors (PPIs) like omeprazole are commonly used to reduce gastric acid secretion and promote clot formation. Additionally, hemostatic agents and vasoactive drugs may be administered. Drugs such as somatostatin and octreotide help control bleeding by reducing splanchnic blood flow and lowering pressure in the veins of the gastrointestinal tract, especially in cases related to variceal bleeding.

Endoscopic Interventions

Variceal Bleeding Management

If the bleeding is caused by ruptured esophageal or gastric varices, endoscopic procedures are often the preferred treatment. Endoscopic variceal ligation (EVL) involves placing rubber bands around the varices to stop the bleeding. Alternatively, endoscopic sclerotherapy or embolization may be used to seal off the bleeding vessels and prevent rebleeding.

Interventional Radiology Procedures

If endoscopic therapy fails to control the bleeding, interventional radiology techniques may be employed. One such procedure is transjugular intrahepatic portosystemic shunt (TIPS), which helps reduce portal pressure and control variceal bleeding. In other cases, arterial embolization may be performed to block off the bleeding vessel, especially in situations involving arterial bleeding from the stomach or duodenum.

Surgical Intervention

When medical therapy, endoscopic treatment, and interventional radiology procedures do not succeed, surgical intervention becomes necessary. Surgery may involve procedures such as vessel ligation, partial gastrectomy, or emergency shunt placement, depending on the underlying cause and severity of the bleeding.