Haematemesis and Malaena

Haematemesis and Malaena:

Investigation

•  Endoscopy of upper GIT-to see bleeding site & band to tie off  bleeding vein
  
• Blood grouping & cross Matching- if need urgent blood
  
• CBC ē PBF- to see any change 
  
• RBS
  
• BT, CT- To exclude bleeding disorder
  
•  S.creatinine
  
• USA of W/A- any abdominal pathology 
  
• liver function test
  
• stool R/M/E  & OBT 

Rx(hospital managemen) 

1.  Bed rest

• Foot end may be rised 
• check vitals sign 

2. 02 inhallation - sos

3. Diet: NPO

Medical Rx:

a.Inf.Hartman ([post id="506" title="Hartmann"])(1L) +

Inf.5%DNS([post id="510" title="DNS"])(1L) +

Inf.5%DA ([post id="511" title="Dextrose "])(1L) ….I/V 30 drop/min.

b. Inj.Maxpro ([post id="392" title="Esomeprazole"])(40mg) 2 vial I/V -Stat & Then 2 vial in 1000ml Fluid 

Then

• Inj.Maxpro(40mg) 1 vial I/V - BD
  

c. Inj. Xamic ([post id="814" title="Tranexamic Acid"]) (500mg) 1 amp lIN - stat & TDS

d. Inj. Oricef ([post id="398" title="Ceftriaxone"]) ( 1gm) 1 vial I/V...BD

e. Tab.Rivotril ([post id="474" title="Clonazepam"])(0.5mg)/inj.sedil 1amp I/m stat

If HTN : Anti hypertensive must 

if Variceal Bleeding : 

• Inj.vasopressin (20i/u in 10cc of 5%DA stat and very slowly)
  
• inj.K-one (10mg) 1 amp I/m stag) 1 amp I/m stat 
• Endoscopic band to tie off bleeding veins
  

During Discharge / Outdoor Treatment:

1.Cap.Denver([post id="399" title="Cefixime"])(400mg)  ...1+0+1.....7 days

2. Cap.Xamic([post id="814" title="Tranexamic Acid"])(500mg)...1+1+1....3 days(if bleeding)

3. Cap.Esonix ([post id="392" title="Esomeprazole"])(20mg)....1+0+1.....10 days(30 min before meal)

4. Tab.Rivo([post id="474" title="Clonazepam"])(0.5 mg)..0+0+1.....10 days (if pt irritable or mentally distrub)

{Treatment of underlying causes(bleeding PUD,HTN,TB }