Bleeding GIT

• for suspected bleeding, can give 40mg IV omeprazole or esomeprazole while waiting for labs, confirming with rectal exam as long as hemodynamically stable
• For active bleeding: 80mg IV then 8mg/hr infusion
• Variceal bleed: Somatostatin 250mcg IV then 250mcg/hr infusion x 5 days -- inhibits vasodilatory hormone like glucagon, indirectly causing splanchnic vasoconstriction and decreased portal inflow.
• others: vasopressin (0.4 U bolus then 0.4 to 1 U/min infusion) or ocreotide - a long-acting somatostatin analog (50mcg then 50mcg/h). Somatostatin is the most superior among the three
• Antibiotics for variceal bleeding
• Maintain Hb to 8 g/dL

Unstable

• Airway: Supplemental oxygen, intubate early
• FFP: known liver disease, don't wait for PT/PTT
• Platelets if indicated
• DDAVP: if renal failure
• PCC:
• Factor VIIa:

Balloon Tamponade: another link

1. Sengstaken-Blakemore: gastric balloon, esophageal balloon, gastric suction port

2. Minnesota: plus esophageal suction port

3. Linton: single gastric balloon, most effective

Lower GI

- Diverticular bleeding, Angiodysplasia

- IR, GS