What is the first step in management of UGI bleed?

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Upper G.I bleed is a medical emergency. The causes can be bleeding from pharynx, oesophagus , stomach and duodenum. Causes are A bleeding peptic ulcer . Bleeding ruptured esophageal varices Acute bleeding gastric erosions A Mallory Weis tear Angiodysplasia . Bleeding disorders Ca stomach Steps in management 1.Initial resuscitation- check vital parameters and if in shock- fluid resuscitation and if possible blood transfusion 2.Endotracheal intubation in critically drowsy patient can save life and even facilitate urgent upper G.I endoscopy 3.Take a detailed history which can give clue to the cause of bleeding like history of APD , cirrhosis of liver , esophagitis 4.URGENT EMERGENCY UPPER G.I ENDOSCOPY is the most important step to save life . If there is bleeding esophageal varices - esophageal banding will immediately stop bleeding Also bleeding peptic ulcer , acute erosions , CA stomach , angidysplasia can be diagnosed- which will help us to plan treatment for respective diseases. If endoscopy is normal - we may think of bleeding disorders

Upper GI bleeding Causes Causes can include: Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading to formation of sores. Tears in the esophagus. Known as Mallory-Weiss tears, they can cause a lot of bleeding. These are most common in people who drink alcohol to excess. Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with serious liver disease. Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease (GERD). R/O the cause and based on which plan the treatment.

First few steps in management of upper GI bleed 1) Check pulse and cardiac activity Check airway and breathing - if compromised intubate and follow advanced cardiac life support guidelines 2) Secure intravenous line for giving fluids. Collect blood from IV line and send it for blood grouping and cross matching, complete blood count, coagulation profile, liver and renal function test, Electrolyte 3) Insert Rules tube - give rules tube wash to remove blood from stomach and reduce chances of vomiting and aspiration 4) Brief assessment to find our Cause of bleeding and start treatment of same

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In ugib correct shock coagulation factor give pack cell transfusion mostly oesopaheal or peptic cause do endoscopy then treat accordingly peptic ulcer oesopaheal varices sclerotherapy usg abdomen

TO CORRECT .. SHOCK AND COAGULATION ABNORMALITIES..AND.. TO STABILIZE PATIENT.. SO..THAT ..THE FURTHER EVALUATION..AND..MANAGEMENT.. CAN BE PROCEED..

Upper gastrointestinal bleed (UGIB) correct shock(if following ACLS Protocol) and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed. Intravenous (IV) fluids, patients may need transfusion of packed red blood cells.Early endoscopy to find out peptic ulcers and gastritis,mallory Weiss tears, varices etc.

Stabilize patient first of all by ABC,hemodynamically unstable if then infuse blood ,cold wash with ns ,once stabilize go with endoscopy within 24hrs

Agree with Dr. Parveen Yograj Sir... well explaine

I agree with Dr.Jayesh Kalbhande

Resuscitation

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