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Medical Regimen for Suspected Variceal Bleed
To review what Dr. Bond and Dr. Winters have already posted:
Three medical therapies have been shown to be effective in patients with severe upper GI bleed thought to be due to esophageal varices:
- Octreatide: 50-100 ug bolus followed by 50 ug/hour. Has been shown to lower the rebleeding rate substantially. Even if varices have not been confirmed by endoscopy, Octreatide has also been shown to be effective in ulcer bleeding as well.
- Antibiotics (3rd generation Cephalosporin): Have been to lower the rebleeding rate in variceal bleeding.
- Intravenous Proton Pump Inhibitor: Remember that a liver patient is as likely to have a non-variceal source of bleeding (ulcer), so add a PPI drip. Raising the pH stabilizes clot. Without endoscopy, you don't know if they have an ulcer or another etiology.
Most of our gastroenterologists recommend this regimen (all three therapies)
Other things to consider:
- Platelets, FFP
- Intubate EARLY-most endoscopists will want the airway protected prior to the scope.
- Don't be too aggressive with blood replacement/IVF: The gastroenterologist don't want these patients too resuscitated with blood products. Certainly don't aim for a Hct >30.