Upper gastrointestinal bleed

Meet the patient

A 58-year-old man with known alcohol-related cirrhosis is brought to the resuscitation bay having vomited bright red blood, then passed a black tarry stool. He is pale, cool, sweating; blood pressure 86 over 52, pulse 122, capillary refill 4 seconds, and he is drifting towards drowsiness. The nurse asks the one question that decides his next drug: is this a variceal bleed or not?^[3]

The answer changes everything that follows. If it is variceal, he gets a vasoactive drug and antibiotics before anyone picks up the scope, transfusion to maintain haemoglobin around 7 to 8 g/dL, and band ligation urgently. If it is non-variceal, the vasoactive is useless and the job is a proton-pump inhibitor, endoscopy within 24 hours, and epinephrine plus a second method. Hold that single fork, and the rest of the station slots into place.^[2][3][13]

References17ShowHide

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