Treatment

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.