Clinical Scenario
Upper GI bleed (variceal & non-variceal)
IMMEDIATE
- A–E. Two large-bore cannulae, group & crossmatch, restrictive transfusion (Hb 70 g/L
- 80 with ACS). Correct coagulopathy: reverse warfarin (PCC + vitamin K), stop DOAC, TXA only if licensed indication. Platelets if <50.
RISK
- Glasgow-Blatchford on admission (0 → outpatient), Rockall post-OGD.
- Treat as variceal if known liver disease until proven otherwise.
NON-VARICEAL
- IV PPI infusion only after endoscopy if high-risk lesion.
- OGD within 24 h (within 12 h if unstable).
- Endoscopic therapy (clips, adrenaline, thermal, glue).
VARICEAL
- IV terlipressin 2 mg QDS + broad-spectrum antibiotics (cefuroxime/ceftriaxone) on suspicion.
- OGD with banding within 12 h.
- TIPSS for refractory bleeding.
- Sengstaken-Blakemore tube as bridge.
DISCHARGE
PPI 8 weeks for peptic ulcer, H. pylori test/treat, NSAID review, beta-blocker for variceal prophylaxis, surveillance OGD.