General

Early management for Upper GI Bleeeding

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8 Sep 2016 - General
 

Patient presented with upper GI bleeding (haematemesis / malaena), can be very sick or unstable. When patient is having a large GI (gastrointestinal) bleeding, 2 wide bore intravenous catheter into the veins are required, so that patient can receive fluid resuscitation or blood trasnfusion as soo as possible ,and as fast as posssible. All the blood tests investigation like full blood count, coagulation screen, blood group and crossmatch, renal profile, liver profile are needed to be done urgently. When patient has unstable upper GI bleeding (means when hypotension and tachycardia), rapid volume resuscitation is important, if failed then will require vasopressors support. Once patient is stabilised, then treamtent like proton pump inhibitor infusion, antibiotic, terlipressin (depend on likely aetiology), should be given, depending on underlying aetiology. Referral to gastroenterolgy or surgery service will be the next step.

For the initial assessment protocol of acute upper GI bleeding, physicians should consider discharging the patient or non-admission with outpatient follow up if: age <60 years, with no evidence of haemodynamic disturbance, no significant comorbidity (especially liver disease, cardiac disease, malignancy), not a current inpatient (or transfer), and no witnessed haematemesis or haematochezia. On the other hand, hospital confinement of patient is considered when age ≥60 years, witnessed haematem...
 (Total 83 words)
Upper GI bleeding is becoming very common these days. It is a medical emergency that is diagnosed either through hematemesis (vomiting of blood or coffee-colored material) or melena (black or tarry stools) and sometimes the occurrence of UGI bleeding does not manifest above symptoms so endoscopy is required to assess the exact case. It has also been seen that few drugs such as NSAIDs (aspirin), clopidogrel and medications responsible for esophagitis can cause or worsen the condition. In the cas...
 (Total 135 words)