Medical Management of Gastrointestinal Hemorrhage

First Things First (assess for & treat the following)

  • Upper GI bleed (UGIB), proximal to ligament of Treitz (LT); lower GI bleed (LGIB), distal to LT
  • Airway protection
    • Consider endotracheal intubation in a pt w/ massive UGI bleeding, especially if he/she has altered mental status; massive bleeds are more commonly seen in variceal bleeding.
  • Circulation
    • Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
      • Hypotension is a late finding in shock. Never underestimate the magnitude of the GI blood loss.
    • Establish two large-bore peripheral lines, or central access if unable to obtain adequate peripheral access.
      • Resuscitate using crystalloids, blood and its components with correction of coagulopathy.

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Last updated: May 10, 2010