Red flags
- Haemodynamic instability
- Melaena + shock
- Suspected variceal (chronic liver disease)
First steps
- ABCDE + 2 large-bore IV + cross-match
- Fluid resuscitation, transfuse if Hb <70 or shock
- Glasgow-Blatchford + Rockall scores
Key investigations
- FBC, U&E, LFT, coag, group & save
- ABG, lactate
- Endoscopy within 24 h (immediately if unstable variceal)
Differentials
- Peptic ulcer (most common)
- Variceal
- Mallory-Weiss tear
- Malignancy, angiodysplasia
Initial management
- PPI: pantoprazole 80 mg IV bolus + infusion (for non-variceal)
- Suspected variceal: terlipressin 2 mg IV q4-6 h + IV antibiotic (ceftriaxone)
- Correct coagulopathy (INR >1.5): PCC/FFP
- Endoscopic therapy (adrenaline + clip/thermal)
- TIPS if refractory variceal
Referral
- GI/hepatology, IR for TIPS if variceal
AI clinical assessment
Enter patient details to generate evidence-based guidance.
This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
