Bleeding Oesophageal Varices
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Commence treatment immediately, before confirmation of diagnosis by endoscopy/barium meal. Resuscitate completely, and only refer when patient is stable.
- Insert large IV cannula to transfuse and to replenish blood volume. Avoid saline unless there is no alternative.
- Correct raised INR/PT with fresh frozen plasma and vitamin K
- Routinely give 3rd generation cephalsporin (ceftriaxone) during acute bleeding.
- Sedate [avoid opiates]
|
Medicine |
Adult dose |
Frequency |
Duration |
|
Diazepam iv |
5-15mg |
as necessary |
|
|
Ceftriaxone iv |
1g |
twice daily |
5 days |
- Treat concurrent encephalopathy as above
- Aspirate nasogastric tube hourly
- If bleeding persists refer: Sengstaken tube should be inserted to arrest bleeding. Refer to specialist.
- Give propranolol indefinitely:
|
Medicine |
Adult dose |
Frequency |
Duration |
|
Propranolol po |
40mg |
2-3 times a day |
indefinitely |