UGI bleed may present as occult or overt bleed. Upper GI bleed is defined as bleeding from any site from pharynx to duodenojejunal flexure or more specifically up to ligament of Treiz and usually presents as hematemesis or melaena (black, tarry, sticky, foul smelling stools)

Features:

·       Occult or overt bleed or fresh blood

·       For diagnosis of GI bleed, need clinical history, examination and radiological/ endoscopic examination

·       Active bleed is indicated by presence of fresh blood in vomitus, nasogastric tube aspirate, malena, passage of fresh blood in the stool

Treatment:

1.     Acute GI bleed is an emergency and needs active management. Blood transfusion if haemoglobin <7g/dl

2.     Maintain vital signs (BP, respiration, airways, temperature)

3.     Insert a large bore IV cannula and send blood samples for Hb, TLC, platelets, coagulation profile, renal and liver function test, blood grouping and cross matching

4.     Start IV fluids like Normal saline/Ringers Lactate/polymer. Replace blood as soon as available, if moderate to severe bleed or active bleed

5.     Inj PPI IV 6 hourly for 72 hours

6.     If variceal bleed is suspected, Inj Octreotide 50 microgram stat followed by 25 microgram/hour infusion or Inj Terlipressin 1-2 mg IV given 4-6 hourly