Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 2: A 46-Year-Old Female With Cirrhosis Came In With Severe Upper Gi Bleeding. Her Proximal Stomach Is Filled With Large Clots And Gastric Varices Are Suspected. How Can I Tell For Certain Endoscopically, And What Is The Treatment? (continued)

Anne Thai, MD; Joseph Leung, MD, FRCP, FACP, FASGE, MACG

The patient presents with severe upper gastrointestinal bleeding (UGIB). The initial approach to the patient is to determine the cause of bleeding. One should conduct a detailed history and physical exam. The history may reveal common causes of UGIB, such as peptic ulcer disease, Mallory-Weiss tear, esophagitis, and esophageal or gastric varices. Because most patients presenting with severe UGIB often cannot give a coherent detailed history, the physical exam should determine the hemodynamic stability of the patient and the need for airway protection, in addition to the urgency of…