GI Bleeding in 12 min

Gastrointestinal Bleeding​

by Moira Carrol, Gurpreet Mudan, and Suzanne Bentley, USA

A 61-year-old man with a history of liver cirrhosis secondary to chronic EtOH abuse presents to the Emergency Department (ED) with a complaint of vomiting bright red blood that began prior to arrival. He arrives actively vomiting; a significant amount of blood is noted in his emesis basin. He is now complaining of dizziness and appears pale.


Gastrointestinal bleeding (GIB) can be generalized into two categories based on the site of bleeding. Upper GIB (UGIB) is defined as any bleeding that occurs proximal to the ligament of Trietz near the terminal duodenum. Lower GIB (LGIB) is any bleeding that occurs distal to the ligament extending to the rectum. Most GIB seen in the ED is attributed to UGIB with an incidence of 90 per 100,000 population. LGIB, on the other hand, presents with a rate of 20 per 100,000 population. LGIB is more commonly seen in the elderly but has a wide range of presentations and causes. As a result, the approach to LGIB has been less standardized.

In a patient without kidney disease, a BUN to Creatinine ratio is an important parameter to decide UGIB presence.

What is the magic number of BUN/Cr ratio?

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In a patient without kidney disease, a BUN to Creatinine ratio that is elevated to greater than or equal to 36 is strongly associated with UGIB.

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