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Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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