MANAGEMENT OF GASTROINTESTINAL BLEEDING:
- The first step is IV fluid of Ringer Lactate or Normal Saline resuscitation using large bore cannula
- Check out A,B,C (Airway, breathing, Circulation, Temperature, blood pressure, pulse rate, etc)
- Send the blood sample for CBC, PT, and in case cross match.
- Find out any Liver abnormality, stigmata, hepatosplenomegaly, or decompromised cirrhosis.
- If PT is elevated, immediately start Fresh Frozen plasma. Vitamin K work too slowly in this regard, so less effective.
- Octreotide is added in treatment to control portal hypertension and developing cirrhosis.
- Naso-gastric tubing, which is used first for diagnostic purpose can be helpful for therapeutic purpose too e.g. in putting saline solution into the bleeding site.
- Endoscopy is used only for finding out etiology of disease.
- Though in more than 85% of patients, spontaneous bleeding resolve by itself, yet Proton Pump Inhibitors and H2- receptor blockers add effectiveness to the treatment plane.
- Sclerotherapy, emergency endoscopy and TIPS (Trans-jugular Intra hepatic Porto-systemic Shunting) are the surgical techniques to stop bleeding.
- Black-more Tube to temponade the site of bleeding in stomach or esophagus is rarely used now a days.
- Beta blockers, propronol is however gaining more and more space in stooping bleeding from varicose.
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