UTILITY OF POINT OF CARE ULTRASOUND TO PREDICT VARICEAL ETIOLOGY INPATIENTS WITH UPPER GASTROINTESTINAL HEMORRHAGE PRESENTING TO THE EMERGENCYDEPARTMENT

Upper GI Hemorrhage is a common ED presentation which can often be life threatening. Massive bleeding can cause hypovolemia and shock. Hence, this requires expedited management. Upper GI hemorrhage can be Variceal or Non Variceal. Diagnosis of variceal bleed usually happens at Endoscopy. Early identification of variceal cause of GI bleed in ED will enable early initiation of octreotide/terlipressin and plan for Emergent UGI scopy. However, in the Emergency Department, diagnosis of Portal Hypertension and varices is challenging. Use of non-invasive predictors of varices including ultrasound parameters by radiologists have found promising results. But, such a study is lacking in the emergency setting. We would like to study if using a non-invasive, easily accessible, bedside POCUS will help us predict varices in patients presenting to the ED with UGI Hemorrhage. Patients who come to the Emergency Department with upper GI bleed, meeting the inclusion and exclusion criteria will be considered for the study. After taking informed consent, patients will be enrolled. The history and physical examination findings will be noted. Point of care ultrasound will be done measuring the portal vein diameter, portal vein patency and blood flow velocity, portal vein congestion index will be calculated. Splenic diameter will be noted.Details will be collected as per proforma. Laboratory markers as sent by treating clinician will be noted. No additional blood test will be sent other than as clinically indicated. No charge will be levied for the point of care ultrasound. All patients with upper gastrointestinal hemorrhage undergo upper GI scopy by gastroenterologist. The findings of the Upper GI scopy, the discharge diagnosis and outcome will be noted. Through this study, our objectives are 1. To assess Diagnostic accuracy of portal vein indices in point of care ultrasound to predict variceal etiology in patients with upper gastrointestinal hemorrhage presenting to the Emergency Department. 2.To compare point of care ultrasound with laboratory markers to predict variceal etiology in patients with upper gastrointestinal hemorrhage presenting to the Emergency Department.