NURS 6501 GASTROINTESTINAL AND HEPATOBILIARY DISORDERS Scenario 3: Upper GI Bleed A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools

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 NURS 6501 GASTROINTESTINAL AND HEPATOBILIARY DISORDERS

Scenario 3: Upper GI Bleed

A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He
stated the first episode occurred last week, but it was only a small amount after he had
eaten a dinner of beets and beef. The episode today was accompanied by nausea,
sweating, and weakness. He states he has had some mid epigastric pain for several
weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed
which won’t be confirmed until further endoscopic procedures are performed.
Question:
1.     What are the variables here that contribute to an upper GI bleed?

Your Answer:
The patient in the case study has a potential diagnosis of upper GI bleed. Several variables
contribute to the development of the upper GI bleed. One of the variables is peptic ulcer
bleeding. Patients with chronic ulcers are increasingly at a risk of developing upper GI
bleed. The bleed arises from severe destruction of the protecting mucosal layer by gastric
secretions. The other variable is gastritis. The irritation and inflammation of the gastric
mucosa increase the risk of its destruction by gastric acid(Graham & Carlberg, 2019).
Over time, gastritis causes upper GI bleed due to the destruction of the mucosal barrier in
esophagus and stomach.
The other variable associated with upper GI bleed is esophagitis. Esophagitis refers
to the inflammation of the esophagus. The inflammation occurs from the different
irritants to the esophageal mucosa. Chronic inflammation may cause altered mucosa
integrity and damage from gastric reflux, hence, the development of upper GI bleed. The
other variable is esophageal varices. Esophageal varices are inflamed veins within the
esophagus. The varices are highly prone to rupture when exposed to stressors such as
straining or irritants(Leebeek& Muslem, 2019). Rupture of the veins cause upper GI
bleeding, hence, a potential cause of the client’s problem in this case study.
The other variable contributing to upper GI bleed that should be considered in the
client is Mallory-Weiss syndrome. Mallory-Weiss syndrome causes tears and bleeding
from the stomach or esophageal lining. Cancer of the upper GI also may contribute to
upper GI bleed. For example, cancers of the stomach or esophagus may cause rupture of
the blood vessels, resulting in the upper GI bleed(Graham & Carlberg, 2019).
Consequently, these potential causes should be ruled out through comprehensive
diagnostics in the patient’s care.

References

Graham, A., & Carlberg, D. J. (2019). Gastrointestinal Emergencies: Evidence-Based Answers
to Key Clinical Questions. Springer.
Leebeek, F. W. G., & Muslem, R. (2019). Bleeding in critical care associated with left
ventricular assist devices: Pathophysiology, symptoms, and
management. Hematology, 2019(1), 88–96.
https://doi.org/10.1182/hematology.2019000067

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