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Non variceal Upper GI bleed



Non variceal Upper GI bleed

Diagnosis

·       History of Hemetemesis or Melena /Hematochezia
·       H/O NSAIDS use /Anti coagulants/antiplatelets/steroids /Peptic ulcer
Examination : Hemodynamic status , vitals
Look for Vascular lesions on the skin
Consider variceal if : Splenomegaly /ascites /Features of CLD    

Investigations

·       Hemogram , RFT,LFT INR Sugar, ECG, X -ray chest  
·       USG to rule out CLD
·       Serology :HBSAg, anti HCV , HIV
·       Plan UGI endoscopy  
·       May need CT angiography  
Severity assessment

·       Endoscopic Findings.      Classification
·       Active bleeding               Ia Brisk bleeding  1b Oozing
·       Non bleeding visible vessel  IIa (visible vessel )
·       Adherent clot                     IIb
·       Flat spot                              IIc
·       Clean base                         III


Click to Calculate  Rockall score: Rockall scoring system

Management

·       NICE guidelines/  ACG guidelines
o   IV Cannula: Insert 2 large bore (18/16G)IV cannulas
o   IV fluids /NPO, No RT Lavage required  
o   Stop NSAIDs, Stop clopidogrel if life-threatening GI bleeding or Hypotension
o   Transfusion :  Maintain   Hb>7-8 gm/dl  
o   Endoscopy: For diagnosis and endotherapy
o   Ongoing bleeding:  May need CT angio /RBC scan
o   Eradicate H pylori if positive
o   Surgical consultation if hemostasis not achieved /ongoing bleed/hypotension/source not identified
  








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