treatment
Last reviewed 01/2018
The most important prognostic factor in gastrointestinal haemorrhage is admission to a specialist unit with defined protocols.
Management is as follows:
- intravenous access
- cross matching of blood, at least four units
- measurement of haemoglobin and haematocrit - being wary of the normal haemoglobin since absence of fluid intake may cause haemodilution
- measurement of clotting - INR and platelets
- measurement of urea and creatinine - urea is raised more in upper tract bleeds by digestion of blood, although this is insensitive
- early surgical assessment
- central line in patients over 65, or with a postural drop, or with a tachycardia
- half hourly observations
- urinary catheter
NB: There is no evidence to suggest that treatment with IV H2-blockers, e.g. ranitidine or cimetidine, reduced the incidence of re-bleeds in patients presenting with acute gastrointestinal haemorrhage.
Similarly proton pump inhibitors do not prevent recurrent bleeding.