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FOCUSED SHIFT VIEW

GI Bleeding

Resuscitate, risk-stratify, find the source.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Resuscitate first: two large-bore IVs, hemodynamics over the first hematocrit.
  2. Upper vs lower from the story; variceal pathway changes drugs and endoscopy timing.
  3. Risk-stratify: Glasgow-Blatchford 0–1 can leave (ACG 2021).

2 · Escalate now if

  • Hemodynamic instability or orthostatic symptoms
  • Active hematemesis or massive hematochezia
  • Cirrhosis with any upper GI bleeding
  • Known AAA repair with any bleed
  • Melena + syncope (brisk upper source)
  • Anticoagulation with life-threatening hemorrhage

3 · Immediate workup

  • Two large-bore IVs; crossmatch early
  • POCUS for ascites; NG lavage is not routinely recommended

4 · Don’t miss

  • Variceal hemorrhage
    Cirrhosis + hematemesis: vasoactive drug (octreotide; terlipressin where available) + ceftriaxone + endoscopy within 12 h; restrictive transfusion (Hb 7–8 g/dL).
  • Aortoenteric fistula
    Prior AAA repair + any GI bleed = fistula until excluded (CTA / surgery).
  • Massive lower GI bleed (diverticular, angiodysplasia)
    Instability directs CTA → IR/endoscopy over colonoscopy-first.
  • Mesenteric ischemia with bleeding
    Bloody stool + pain out of proportion in a vasculopath.
  • Anticoagulant-associated bleeding
    Agent-specific reversal for life-threatening hemorrhage; balance thrombosis risk (ACG/CAG 2022).

5 · Disposition lane

Admit (ward / HDU)

GBS ≥2, identified stable source, anticoagulation management needed.

ICU / endoscopy-IR activation

Hemodynamic instability, active transfusion need, suspected variceal bleed, aortoenteric fistula.