See here! Locating the source of upper GI bleeding

A 59-year-old woman presented to the emergency department of a hospital with tertiary hepatology services reporting upper abdominal pain and black stools. She was known to have alcohol-related cirrhosis (Child Pugh A6) under routine hepatology follow-up, and was an active drinker. Medical history included hypertension, hypothyroidism and a Roux-en-Y (RNY) gastric bypass for obesity 10 years previously.\n\nThe patient was tachycardic but normotensive with melaena on digital rectal examination. Haemoglobin was 98 g/L from 148 g/L preadmission (reference range 115–55 g/L). Glasgow Blatchford Score was 9. She was fluid resuscitated and broad-spectrum antibiotics and terlipressin administered. An emergency oesophagogastroduodenoscopy (OGD) identified grade 1 oesophageal varices with no high-risk stigmata of bleeding. There was no fresh …