Synopsis
Recognise upper gastrointestinal haemorrhage, resuscitate according to physiology, apply validated risk assessment, and coordinate time-critical endoscopic and variceal treatment with safe antithrombotic and transfusion decisions.
- Assess circulation and airway before debating ulcer versus varix; massive haematemesis and encephalopathy create a high aspiration risk that may require anaesthetic airway control.
- Two large-bore venous cannulae, blood count, renal and liver profiles, coagulation, group-and-save or crossmatch, lactate and frequent observations support resuscitation, but haemoglobin may initially appear normal.
- Use the Glasgow-Blatchford score at first assessment and the full Rockall score after endoscopy; a score supports disposition but never overrides active shock or clinical concern.
Key red flags
Tachycardia, hypotension, narrow pulse pressure, cool peripheries, oliguria, altered mentation or raised lactate indicates inadequate perfusion. Beta-blockers and pacing can blunt tachycardia, so trends and end-organ signs matter.
Investigation priorities
Quantify perfusion, airway risk and response to resuscitation before and after haemostasis.
Management branches
Haematemesis, coffee-ground vomit or melaena is reported or observed.
- Begin ABCDE, assess aspiration and encephalopathy, obtain two adequate venous lines, monitor continuously and send urgent crossmatch and organ profiles.
- Give warmed blood and fluids according to physiology and the local haemorrhage protocol, correcting hypothermia and major metabolic disturbance without over-resuscitating portal hypertension.
Key medicines
Terlipressin for suspected variceal bleedingStart at presentation using the current BNF and local variceal-haemorrhage regimen, continuing until definitive haemostasis or the guideline maximum duration unless adverse effects intervene.
Prophylactic antimicrobial therapy in variceal bleedingGive the locally recommended intravenous prophylactic regimen promptly in suspected or confirmed variceal haemorrhage, adjusted for allergy, renal function and local resistance.