Risk Stratification:

• Glasgow-Blatchford Score (pre-endoscopy): To assess the urgency for endoscopy.
• Rockall Score (post-endoscopy): To assess the risk of morbidity and mortality following the procedure.

Management:

• Resuscitation:
  • Administer IV fluids to maintain circulation and ensure proper hydration.
  • If the patient’s Hb drops below 7 g/dL (or 8 g/dL in patients with cardiovascular disease), consult with senior colleagues about blood transfusion.
  • Follow local protocols for managing bleeding and coagulopathy, including potential use of blood products.
• If Suspected Variceal Bleed:
  • Start terlipressin with senior approval (monitor closely for side effects like ischaemia).
  • Administer prophylactic antibiotics (IV ceftriaxone) to reduce the risk of infections.
  • Prepare for early endoscopy for potential variceal band ligation.
• If Suspected Non-Variceal Bleed:
  • Arrange for urgent endoscopy to identify the bleeding source and control it (e.g., variceal banding, adrenaline injection, ulcer clipping).
  • Administer PPI therapy as per local guidelines (usually to reduce gastric acid and help control bleeding).
• Endoscopic Techniques:
  • Endoscopy may involve variceal banding, adrenaline injection, or ulcer clipping to control the bleeding.
  • If variceal bleeding is severe, further measures like a Sengstaken-Blakemore tube or TIPS (Transjugular Intrahepatic Portosystemic Shunt) may be required.