Most common cause of upper GI bleeding?

Chitranjjan National Cancer Institute Kolkata - 2021

Pathology & Genetics

Easy

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Peptic ulcer disease (PUD), which encompasses both gastric and duodenal ulcers, is the single most frequent cause of upper gastrointestinal bleeding (UGIB).
According to clinical data, PUD accounts for approximately 50% of all hospital admissions for UGIB.
Among the choices provided, 'Gastric ulcer' is a primary component of PUD and represents this most common category.

Option B: While esophageal varices can cause severe, life-threatening hemorrhage, they are less common overall than peptic ulcers. They are a specific complication of portal hypertension, most often seen in patients with advanced liver disease (cirrhosis).
Option C: Erosive gastritis is a frequent finding but accounts for a smaller percentage of significant UGIB hospitalizations (up to 30%) compared to peptic ulcers. The bleeding from gastritis is often diffuse and less severe than that from a deep ulcer.
Option D: Stomach cancer (carcinoma) is an uncommon cause of acute, massive upper GI bleeding, accounting for less than 5% of cases. It is more likely to cause chronic, occult blood loss leading to iron deficiency anemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Upper Gastrointestinal (GI) Bleeding as background academic context rather than a clinical decision trigger.
The immediate nursing priority for a patient with suspected UGIB is to assess hemodynamic stability by checking heart rate and blood pressure, as this guides the urgency of intervention.
Nurses must be prepared to act quickly: secure two large-bore IV lines for resuscitation, administer oxygen, place the patient on NPO status, and prepare for potential blood transfusions and an urgent endoscopy.
What if? If a patient with suspected UGIB has a known history of advanced liver cirrhosis, the nurse's primary suspicion should shift towards esophageal varices. This requires preparing for the administration of vasoactive drugs (like octreotide) and anticipating an urgent endoscopic variceal ligation procedure.

How to Approach the Question

This is a factual recall question that asks for the 'most common' cause of a specific medical condition.
First, identify the key clinical concept: 'upper GI bleeding'.
Next, focus on the qualifier in the question: 'most common cause'. This requires knowledge of epidemiology.
Review the options provided: Gastric ulcer, Esophageal varices, Gastritis, and Carcinoma stomach.
Mentally rank these conditions by their prevalence as a cause of UGIB. Recall that peptic ulcers are a very common pathology of the stomach and duodenum.
Eliminate less frequent or more specific causes. Esophageal varices are primarily linked to liver disease, and cancer is a much rarer cause of acute bleeding compared to ulcers.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 1 pp. 358-360, 359-361