The initial focus is on resuscitation beginning with airway management and fluid resuscitation using either intravenous fluids and or blood. A number of medications may improve outcomes depending on the source of the<unk> . Proton pump inhibitor medications are often given in the emergent setting before an endoscopy and may reduce the need for an endoscopic haemotstatic treatment. Proton pump inhibitors decrease gastric acid production. There is insufficient evidence to determine if proton pump inhibitors decrease death rates, re-bleeding events, or the need for surgical interventions. After the initial resuscitation has been completed, treatment is instigated to limit the likelihood of re-bleeds and correct any anemia that the<unk>  may have caused. Those with a Glasgow Blatchford score less than 2 may not require admission to hospital. Peptic ulcers Based on evidence from people with other health problems crystalloid and colloids are believed to be equivalent for peptic ulcer<unk> . In people with a confirmed peptic ulcer, proton pump inhibitors do not reduce death rates, later<unk>  events, or need for surgery. They may decrease signs of<unk>  at endoscopy however. In those with less severe disease and where endoscopy is rapidly available, they are of less immediate clinical importance. Tranexamic acid might be effective to reduce mortality, but the evidence for this is weak. But the evidence is promising. Somatostatin and octreotide while recommended for variceal<unk>  have not been found to be of general use for non-variceal bleeds. Variceal<unk>  For initial fluid replacement colloids or albumin is preferred in people with cirrhosis. Medications typically includes octreotide or if not available vasopressin and nitroglycerin to reduce portal pressures. This is typically in addition to endoscopic banding or sclerotherapy for the varices. If this is sufficient then beta blockers and nitrates may be used for the prevention of re-bleeding. If<unk>  continues then balloon tamponade with a Sengstaken-Blakemore tube or Minnesota tube may be used in an attempt to mechanically compress the varices. This may then be followed by a transjugular intrahepatic portosystemic shunt. Blood products If large amounts of pack red blood cells are used additional platelets and fresh frozen plasma should be administered to prevent coagulopathies. Some evidence supports holding off on blood transfusions in those who have a hemoglobin greater than 7 to 8 g/dL and only moderate<unk> . If the INR is greater than 1.5 to 1.8 correction with fresh frozen plasma, prothrombin complex may decrease mortality. Procedures The above ulcer seen after endoscopic clipping The benefits versus risks of placing a nasogastric tube in those with upper gastrointestinal<unk>  are not determined. Endoscopy within 24 hours is recommended. Prokinetic agents such as erythromycin before endoscopy can decrease the amount of blood in the stomach and thus improve the operators view. Early endoscopy decreases hospital time and the amount of blood transfusions needed. Proton pump inhibitors, if they have not been started earlier, are recommended in those in whom high risk signs for<unk>  are found. It is also recommended that people with high risk signs are kept in hospital for at least 72 hours. Blood is not recommended to correct anaemia, unless the patient is cardiovascularly unstable as this can worsen outcomes. Oral iron can be used, but this can lead to problems with compliance, tolerance, darkening stools which may mask evidence of rebleeding and tends to be slow, especially if used in conjunction with proton pump inhibitors. Parenteral Iron is increasingly used in these cases to improve patient outcomes and void blood usage.
types of Gastrointestinal bleeding
symptom of Abscess
symptom of Gastrointestinal bleeding
types of Head injury
symptom of Hemorrhoid
symptom of Pancreatitis
causes of Hematochezia
medical cause of Infection