2.  I/V access with large bore cannula
 Basic investigations-blood count,routine
biochemistry,cross match blood
 Hourly measurements of Bp,pulse and urine output..
 i/v colloids or crystalloids –pt with hypotension and
tachycarda
 Transfuse with blood
 Endoscopy for diagnosis & Rx
 Iv PPI therapy for bleeding peptic ulcer

3.  0.9 % saline
 Vasopressor(terlipressin)
 Prophylactic antibiotics
 Emegency endoscope
 Variceal band ligation
 Proton pump inhibitor
 Phosp[hate enema/lactulose enema

4.  ENDOSCOPIC THERAPY with
* Bipolar electro coagulation
* Heater probe
* Injection therapy
- Absolute alcohol
- 1:10000 epinephrine
- Clips
 High dose constant infusion of iv
PPI E.g. Omeprazole – 80 mg
bolus & 8 mg/hr infusion

5.  Eradication of H.Pylori infection
 Discontinue NSAIDS & acids
 If NSAIDS have to be used, use along with PPI
 Use selective COX-2 inhibitors like Coxib or
traditional NSAIDS + Coxib
 Coxib + PPI : further significant decrease in
ulcers and recurrent bleeding.

6.  Mostly bleeding stops
spontaneously ( Recurrence is
only 0-7 % )
 Endoscopic therapy is only for
actively bleeding Mallory weiss
tear.
 Angiographic therapy with
embolization & operative
therapy with over sewing of
tear can be done ( but only
required rarely )

7. I. Vasoconstrictors (somatostatin, octreotide,
terlipressin) iv terlipressin infusion at 2 mg 6th
hourly, generalized vasoconstriction leading to
decreased blood flow to venous system.
II. Baloon tamponade – Triple lumen or Four lumen
tube with esophageal and gastric balloons.
(Always intubate the patient prior to this
procedure to prevent aspiration)
III. Endoscopic variceal liagation[Band ligation]
IV. Sclerotherapy
V. Antibiotic therapy

8.  Quinolones – for patients with cirrhosis
decreases the bacterial infection & mortality.
 Non selective Beta blockers – Propranalol,
Nadolol
 For recurrent esophageal bleeding – c/c therapy
with beta blocker + endoscopic ligation
 If not subsided with medical therapy, Go for:

9. INVASIVE THERAPY:
 TIPss (Transjugular intrahepatic portosystemic
shunt)
 A/E : Hep encephalopathy, shunt stenosis in 1 yr
 Vascular ectasias are treated by endoscopic
therapy
 Estrogen / progesterone components are used in
vascular ectasias

10.  avoiding the long-term use of
alcohol, NSAIDs, coffee, high-
fat foods and drugs
 Reducing stress through
relaxation techniques
 Antacids, H2 blockers, PPIs
 Triple therapy: 2 antibiotics + a
PPI is commonly used to treat
H. Pylori related gastritis

12. Thank you….