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Acute Upper GI Bleed

  1. ABC. Protect airway and keep NBM. Insert 2 large bore cannula.
  2. Bloods: FBC, U+E, glucose, clotting, cross-match 6 units (or G+S), LFTs
  3. High flow oxygen
  4. Rapid IV colloid infusion
  5. If remains shocked give blood. Correct clotting abnormalities
  6. Set up CVP line to guide fluid replacement. Catheterize.
  7. Notify surgeons.
  8. Urgent endoscopy for diagnosis and control of bleeding (<4h for variceal, 12-24h for other)
  9. Varices: banding, sclerotherapy. If bleeding continues pass Sengstaken-Blakemore tube. Avoid hepatic encephalopathy.
  10. IV omeprazole

Causes

Peptic ulcer (40%) > MV tear (15%) > GD erosions (10%) > oesophagitis

Symptoms/Signs

Haematemesis, melaena, dizziness, abdominal pain, dysphagia, postural hypotension/hypotension, tachycardia, telangiectasia or purpura, jaundice
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