Acute Gastrointestinal Luminal Hemorrhage
Gastrointestinal bleeding in the emergency or intensive care unit setting can present significant diagnostic and management challenges. Initial care is focused on airway stabilization, aggressive fluid and blood product resuscitation, and correction of coagulopathy/thrombocytopenia. Subsequent diagnosis (and often treatment), both of upper and lower gastrointestinal bleeding, can usually be accomplished with a combination of endoscopy and angiography. Nuclear medicine studies, capsule endoscopy, and other techniques are employed if the initial measures fail. Variceal bleeding can be managed similarly, although often medical or infusion management is added. Rarely, surgical intervention is required for unstable, refractory, or difficult to localize hemorrhage.