View source for Template:UGIB evaluation

===Workup===
*2 large bore IVs (or [[sheath introducer]])
*Type and cross
*CBC & serial hemoglobin
*Chemistry
**BUN/creatinine >30 suggests UGI if no history of renal failure (increased absorption/digestion of hb)
*Coags 
*[[LFTs]]
*Fibrinogen 
*Guiac
**More useful for diagnosing chronic occult bleeding (it could be positive for up to 2 weeks after an acute bleed)
**False-positive: vitamin C, red meat, methylene blue, bromide preparations, turnips, horseradish
*[[ECG]] (if >40 yo or if suspicious for silent MI, especially from demand ischemia)
*[[CXR]] (if suspect perforation)

===NG Lavage Controversy===
*'''Pros'''<ref name="ali">Aljebreen AM et al. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc. 2004;59(2):172-178.</ref>
**Positive aspirate proves strong evidence for an upper GI source of bleeding
**Can assess presence of ongoing active bleeding
**Can prepare patient for endoscopy
*'''Cons'''<ref name="ali"></ref>
**Uncomfortable
**Negative aspirate does not conclusively exclude upper GI source
**Provides useful information in only minority of patients without hematemesis
**[[Erythromycin]] 200mg IV can provide equal endoscopy conditions as lavage<ref>Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74(5):971-980.</ref>

===Diagnosis===
*Endoscopy frequently required for definitive diagnosis of underlying etiology