Pitfalls

In assessing the patient with an upper GI bleed there are several pitfalls. The most important of these is failing to recognise those patients that require prompt resuscitation, urgent endoscopy and admission to a critical care area (haemodynamic abnormalities or a Rockall score of three or more).

It is vital, in a shocked patient with no apparent cause, to perform a rectal exam early to avoid missing melaena. Be aware of the patient with an unexplained postural hypotension or syncope and assess for an unrecognised GI haemorrhage.

In terms of variceal bleeds: consider antibiotics and terlipressin early. If considering a Sengstaken tube, remember to secure the airway prior to its’ insertion.