The document outlines various procedures and treatments for gastrointestinal bleeding including: 1) Establishing IV access and administering fluids, blood transfusions, vasopressors, antibiotics, and performing endoscopy for diagnosis and treatment. 2) Endoscopic procedures include band ligation, coagulation, and injection therapies to stop active bleeding. 3) Long term management involves eliminating risk factors, treating H. pylori infections, and using proton pump inhibitors.

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….