Polyp, inflammatory bowel disease, malignancy and aortoenteric fistula
Management
Triage and evaluate the patient on priority basis
Primary survey to find, is patient showing signs of haemodynamic compromise
Resuscitate the patient using standard ABCD approach
Target oriented history,incl. PMHx of IBD, peptic ulcer, aortic surgery,etc
Medications to note: NSAIDs, Steroids and anticoagulants
Record vita signs and perform cardiac, pulmonary, abdominal and rectal exam
Investigations
Blood grouping and cross matching of 4 to 6 units
FBC, Urea and electrolytes,glucose
Coagulation profile and fibrinogen levels
ECG
Treatment
Maintain airway and provide high flow oxygen
Attach ECG monitor & pulse oximeter
Insert two large bore IV cannula in forearm veins(14G)
IV fluids (crystalloid)or blood according to haemodynamic response
NG tube Urinary catheter
CVP line if thermodynamically unstable
Consult Surgical team on call
If the source is upper GI then PPI (Losec)infusion at a rate of 8mg /hr is recommended
Somatostatin should be considered in unwell patients with acute non variceal GI bleed who are likely to be bleeding from PUD, or where endoscopy is contraindicated or unavailable.[BestBets]