Editing Upper GI bleed (section)

=== Identify cause ===

## Aim endoscopy at 8-24 hours (unless meets indications for immediate endoscopy - below)

### Consider IV metoclopramide 10mg or erythromycin 3mg/kg, 1 hour prior to endoscopy as a prokinetic (erythromycin has more convincing data behind it to reduce need for second-look endoscopy, but metoclopramide is probably better than nothing)
### Consider putting a nasogastric lavage tube on standby if active bleeding and going to endoscopy
### If can't see anything because of blood - try repositioning the patient upright

## Indications for immediate endoscopy:

### Suspected variceal bleeding
### Non-responder or transient responder to resuscitation

## PUD - will need endoscopy. If suspected bleeding ulcer should be within 24 hours. If serious bleeding, 12 hours. Endoscopy within 8 hours can often mean a bad view and worse outcomes! So aim 8-12 hours.
## Oesophagitis/gastritis
## Varices - look for evidence of portal hypertension - see below for specific management

# Post-procedure care

## A conservative approach would be to keep to clear fluids for 48 hours if bleeding was found
## Consider abdo USS to exclude portal vein thrombosis
## Classically an NGT on suction would be used to assess for re-bleeding, but this is unnecessary and causes disproportional discomfort