In patients with acute upper GI bleeding who are unstable rapid assessment and resuscitation should be initiated even before diagnostic evaluation. The initial steps in the management of a patient with UGIB is to assess the severity of bleeding, and then institute fluid and blood resuscitation as needed. Once hemodynamic stability is achieved, a proper clinical history, physical examination, and initial laboratory findings are crucial not only in determining the likely sources of bleeding but also in directing the appropriate intervention. Equilibration between the intravascular and extravascular volumes cannot be achieved  until 24 to 72 hours after bleeding has occurred. Nasogastric lavage should be performed if the presence or source of bleeding is unknown. Upper gastrointestinal endoscopy is the primary diagnostic tool, performed for both diagnosis and treatment of active bleeding. The American Society for Gastrointestinal Endoscopy guidelines recommends upper endoscopy within 24 hours of presentation in all patients with UGIB. Angiography and tagged erythrocyte scan are rarely needed but may be used to diagnose active UGIB, particularly in patients where EGD is contraindicated. Also, upper gastrointestinal tract radiographic studies using barium are generally not advised, as they may obscure visualization during EGD.
Upper gastrointestinal bleeding initial resuscitation
Lower gastrointestinal bleeding initial resuscitation
Lower gastrointestinal bleeding endoscopic intervention
Hematemesis other diagnostic studies
Upper gastrointestinal bleeding endoscopic intervention
Upper gastrointestinal bleeding other diagnostic studies
Lower gastrointestinal bleeding other diagnostic studies
Jaundice other diagnostic studies