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Gastrointestinal bleeding: Difference between revisions
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== Treatment == | == Treatment == | ||
In case of acute bleeding, urgent assessment and stabilisation are crucial. If the patient is haemodynamically unstable they must be stabilised first. This involves monitoring, replacing lost fluids, and blood transfusion. Blood transfusion is indicated at haemoglobin level < 70 g/L, with a target of 70 – 90 g/L. | In case of acute bleeding, urgent assessment and stabilisation are crucial. If the patient is haemodynamically unstable they must be stabilised first. This involves monitoring, replacing lost fluids, and blood transfusion. Blood transfusion is indicated at haemoglobin level < 70 g/L, with a target of 70 – 90 g/L. Intubation may be necessary to protect the airway. | ||
Then, we should determine the source of the bleeding, stop it, treat the underlying condition, and prevent recurrent bleeding. | Then, we should determine the source of the bleeding, stop it, treat the underlying condition, and prevent recurrent bleeding. This may include [[terlipressin]] for [[Variceal bleeding|varices]]. | ||
Upper endoscopy is | Upper endoscopy is the main tool in the evaluation of acute upper GI bleeding, as it allows for both diagnosis and treatment of the underlying cause. It should be performed as soon as possible when the patient is haemodynamically stable. Administering erythromycin prior to endoscopy is useful, as its prokinetic properties help remove residual blood and gastric content. | ||
If there is active bleeding, a non-bleeding visible vessel, or an adherent clot to the ulcer, endoscopic therapy with IV PPI is indicated. If there is a flat spot or clean based ulcer, no endoscopic therapy is necessary, only oral PPI. Endoscopic haemostasis may be achieved with: | |||
* Electrocoagulation | * Electrocoagulation | ||