Variceal bleeding

TO DO LIST

1. Fluid resuscitation to a target mean arterial blood pressure of 65 mmHg: Ringer acetate.
2. Plan for urgent endoscopy.
3. Intravenous terlipressin 2 mg four times a day  (in patients without a history of ischaemic heart disease or peripheral vascular disease).
4. Blood transfusion given if the haemoglobin falls below 7 g/dL, to a target of 8 g/dL.
5. Nasogastric sond.
6. Consider PPI i.v. ( esomeprazol or pantoprazol) 80 mg bolusdos and after that  infusion 8 mg/h i 72 hours. 
7. Consider reversal of anticoagulation (Ocplex) 1500 IE (10-30 IE/kg)  or Confidex, Konakion 10 mg i.v. 
8. Antibiotic profylax (reduces the risk of repeat bleeding, spontaneous bacterial peritonitis).

Resources:

Jairath V, Rehal S, Logan R, et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis 2014;46(5):419-26.