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