Ọbara ọgbụgba nke eriri afọ: ịgba agbọ ọbara na stool ojii¶

Acute gastrointestinal (GI) bleeding is a medical emergency in which blood escapes from a ruptured blood vessel, ulcer, or tear anywhere along the digestive tract, from the esophagus and stomach (upper GI bleed) down to the small intestine, colon, and rectum (lower GI bleed). Unlike an external wound on an arm or leg, you cannot press your hands directly onto a bleeding stomach ulcer or ruptured esophageal varix, and the stomach and intestines can silently conceal 1,000 to 2,000 milliliters (2 to 4 pints) of blood before a single drop is vomited or passed in the toilet. Whether someone is vomiting bright red blood or dark "coffee-ground" material (hematemesis), passing sticky jet-black tarry stools (melena), or passing large amounts of maroon or bright red blood from the rectum (hematochezia), your immediate priorities are calling emergency medical services, rolling a vomiting person onto their side so they do not drown in aspirated blood, keeping them strictly nothing by mouth (NPO), and laying them down to prevent fatal hypovolemic shock.

Mee nke a ugbu a¶

1. Call your local emergency number immediately if the person is vomiting blood, passing black tarry stools with dizziness, or bleeding heavily from the rectum. Dial 911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, or see all nọmba mberede. Tell the dispatcher whether the patient is vomiting bright red blood, has liver cirrhosis, or takes blood thinners (anticoagulants), as this triggers advanced paramedic airway and blood-transfusion protocols.
2. Protect the airway by placing any vomiting or drowsy person on their side (Recovery Position). If the person is actively vomiting blood (hematemesis), retching, or becoming drowsy, confused, or unconscious, immediately roll them onto their left side into the lateral recovery position and tilt their chin slightly downward so blood and clots drain freely out of the corner of their mouth into a basin or towel. Use a finger wrapped in a cloth to sweep any large rubbery blood clots out of the front of their mouth if they are gagging.
3. Lay a non-vomiting, dizzy person flat on their back to prevent fainting and shock. Do not allow a person with suspected GI bleeding to walk down stairs, stand at the bathroom sink, or sit upright on the toilet if they feel lightheaded. Standing upright when blood volume is depleted causes blood pressure to plummet (orthostatic syncope), leading to sudden collapse, severe head injuries on bathroom tiles, and cardiac arrest. If they are fully alert and not nauseated or vomiting, lay them flat on the floor or bed.
4. Give strictly NOTHING by mouth (no water, no milk, no antacids, and never aspirin or NSAIDs). Do not let the person drink water, milk, or herbal teas, and do not give oral antacids or bismuth. Most importantly, never give aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, or ketorolac for stomach pain: these nonsteroidal anti-inflammatory drugs (NSAIDs) strip away the stomach's protective mucus barrier and paralyze blood platelets, turning a slow ulcer bleed into a torrential arterial hemorrhage.
5. Keep the person warm with blankets to protect blood clotting. Cover the patient with a warm blanket or coat and place a blanket underneath them if they are lying on a cold bathroom floor. When a bleeding patient becomes cold (hypothermia below \(35^\circ\text{C}\) or \(95^\circ\text{F}\)), the enzymatic clotting cascade and blood platelets stop working properly (part of the "Lethal Triad of Trauma and Hemorrhage"), causing uncontrollable bleeding.
6. Save a sample or take a smartphone photo of the vomit or stool, and gather all medication bottles. Before flushing the toilet or throwing away a basin of vomit, snap a clear photograph with your phone or save the container to show paramedics (doctors need to see the exact color, clots, and estimated volume). Gather every prescription and over-the-counter bottle in the house, specifically checking for blood thinners (warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel), aspirin/NSAIDs, steroids, and iron or bismuth supplements.

Gastrointestinal bleeding triage and first aid decision flowchart¶

Use this clinical decision tree to identify the source and severity of digestive tract bleeding and take immediate life-saving steps.

flowchart TD
    Start["Suspected Gastrointestinal (GI) Bleeding:<br/>Blood in Vomit, Black Tarry Stool, or Red Rectal Bleeding"] --> AirwayShock{"Check Airway & Shock Signs Immediately:<br/>- Vomiting bright red blood or coffee-grounds?<br/>- Dizzy, fainting, pale, cold clammy sweat?<br/>- Fast heart rate (>100 bpm), confusion, or liver disease?"}

    AirwayShock -->|"YES: Active Hematemesis or Shock"| Emergency911["1. Call 911 / 112 / 999 Immediately<br/>2. If vomiting or drowsy: Roll into Left Lateral Recovery Position<br/>3. If alert & NOT vomiting: Lay flat on back<br/>4. Keep Strictly Nothing by Mouth (NPO)<br/>5. Cover with warm blanket & monitor breathing"]

    AirwayShock -->|"NO: Awake, stable, not vomiting"| StoolColor{"What does the stool or toilet bowl look like?"}

    StoolColor -->|"Jet-Black, Sticky, Tarry Stool<br/>with Foul Odor (Melena)"| MelenaCheck{"Did patient take Iron pills, Pepto-Bismol,<br/>activated charcoal, or black licorice?"}
    MelenaCheck -->|"No (or unsure)"| MelenaER["TRUE MELENA = Upper GI Bleed (>50 to 100 mL blood in stomach):<br/>Go to Hospital Emergency Department Immediately<br/>(Call 911 / 112 / 999 if elderly, on blood thinners, or weak)<br/>Do NOT drive yourself; stay Nothing by Mouth"]
    MelenaCheck -->|"Yes, and ZERO stomach pain,<br/>dizziness, or weakness"| Pseudomelena["Likely Pseudomelena (harmless dark green/black staining):<br/>Contact physician same day to confirm with fecal occult blood test"]

    StoolColor -->|"Large volume Maroon Clots or<br/>Bowl Full of Bright Red Blood (Hematochezia)"| BriskLower["Brisk Lower GI Bleed (or Massive Rapid Upper GI Bleed):<br/>Call 911 / 112 / 999 or Emergency Hospital Transport Immediately<br/>Lay flat, keep warm, bring all blood thinner bottles"]

    StoolColor -->|"Small streaks of bright red blood ONLY<br/>on toilet paper after hard stool"| MinorAnorectal["Likely Hemorrhoids or Anal Fissure:<br/>Schedule prompt doctor evaluation to rule out colorectal polyps/cancer<br/>Go to ER immediately if bleeding does not stop or dizziness develops"]

Decoding the 4 visual patterns of GI bleeding: What color tells you¶

As blood travels through the human digestive tract, stomach hydrochloric acid, digestive enzymes (pepsin), and intestinal bacteria chemically alter the red hemoglobin molecule inside red blood cells, changing its color from bright crimson to dark brown-black. By looking closely at what was vomited or passed into the toilet, you can pinpoint where the bleeding is coming from and how fast it is happening.

Mkpu ụgha: Ịmata ọdịiche dị n'ezie ọbara na nri na-adịghị emerụ ahụ na nsị pill ("Pseudomelena")¶

Tupu ị tụọ ụjọ n'elu stool gbara ọchịchịrị ma ọ bụ ọbara ọbara na onye nwere ahụ ike zuru oke, nwere ụbụrụ nkịtị, yana enweghị isi ọwụwa ma ọ bụ mgbu afọ, lelee ma ha riri otu n'ime ihe ndị a na-emekarị n'ime awa 24 ruo 48 gara aga:

• ** Ihe nṅomi nke Black Melena ("Pseudomelena") na-adịghị emerụ ahụ:
• Ihe mgbakwunye iron nke ọnụ *** ( sulfate sulfate, ferrous gluconate, vitamin prenatal): na-atụgharị stool ka ọ bụrụ agba ojii na-acha akwụkwọ ndụ akwụkwọ ndụ, ** mana stool nwere ọdịdị kwụ ọtọ (ọ bụghị tar na-arapara) na enweghị isi na-esi ísì ụtọ nke ọbara gbazere.
• **Bismuth Subsalicylate (Pepto-Bismol, Kaopectate): Bismuth na-emeghachi omume na sọlfọ trace na saliva na eriri afọ na-etolite ** black bismuth sulfide **, na-atụgharịkarị ** ma ire ma stool jet-black **.
• ** Unyi arụ ọrụ ***, ** licorice ojii ***, ** kuki chọkọletị/Oreo gbara ọchịchịrị, ma ọ bụ ** nnukwu ọkwá nke blueberries gbara ọchịchịrị / ihe ọṅụṅụ mkpụrụ vaịn.
• ** Ngosipụta na-adịghị emerụ ahụ nke Red Hematochezia / Red Vomit**:
• ** Red beets (beetroot / betanin pigment) ***, ** gelatin na-acha uhie uhie (Jell-O) ***, **Kool-Aid / ihe ọṅụṅụ egwuregwu na-acha uhie uhie **, ** agba agba nri na-acha ọbara ọbara, ** mkpụrụ osisi dragọn **, ma ọ bụ ** nnukwu ihendori tomato.
• ** Iwu nchekwa ***: Ọ bụrụ na enwere obi abụọ ọ bụla, ma ọ bụ ọ bụrụ na onye ahụ nwere mgbu afọ, adịghị ike, ọsụsọ, ma ọ bụ na-ewere aspirin / ọbara thinner, ** na-emeso ya mgbe niile dị ka ezigbo ọbara wee gaa na mberede ụlọ mberede ** (nyocha ọbara mgbaasị ụlọ ọgwụ 30 nke abụọ ma ọ bụ mkpịsị aka hemoglobin na-edozi ajụjụ ahụ ozugbo).

Isi ihe na-ebute ọbara ọgbụgba nke elu na nke ala¶

Ịghọta ihe na-akpata ọbara ọgbụgba GI na-enyere gị aka ịnye ndị na-ahụ maka ahụike na ndị dọkịta mberede akụkọ ahụike dị egwu.

1. Ọbara GI dị elu na-akpata (75% ruo 80% nke nnabata ọbara GI niile n'ụlọ ọgwụ)¶

• Ọrịa peptic ọnyá afọ (Gastric na Duodenal Ulcer: 40% na 50% nke elu bleeds)**: Ọnya miri emi na-emebi n'ime lining nke afọ ma ọ bụ akụkụ mbụ nke obere eriri afọ (duodenum), ihe fọrọ nke nta ka ọ bụrụ mgbe niile na-akpata ma *** Helicobacter pylori (*H. pylori) ọrịa nje na-egbu egbu nke NSAID, ma ọ bụ ihe mgbu na-egbu egbu. Naproxen, aspirin, meloxicam, diclofenac)**. Mgbe ọnya ọnya na-agbada n'ime submucosa wee mebie mgbidi nke nnukwu akwara (dị ka gastroduodenal artery n'azụ duodenum ma ọ bụ ** eriri afọ nke aka ekpe **), ọbara na-agbaba n'okpuru nnukwu ọbara mgbali n'ime eriri afọ.
• ** Esophageal na Gastric Varices (10% ruo 20% nke ọbara elu, ọnụ ọgụgụ kachasị elu) : N'ime ndị ọrịa nwere ** imeju imeju (site na ịṅụ mmanya na-aba n'anya, ịba ọcha n'anya B ma ọ bụ C, ma ọ bụ ọrịa imeju abụba) ma ọ bụ thrombosis portal vein thrombosis, anụ ahụ dị na imeju na-egbochi ọbara nkịtị si na eriri afọ. Nrụgide na-akwado na vein portal (* portal hypertension *), na-amanye ọbara ka ọ pụọ site na veins na-esighị ike, nke nwere obere mgbidi na-ekpuchi esophagus dị ala na afọ elu ( varices ***), nke na-aza dị ka veins varicose. Mgbe varix gbawara, ọ na-ebute vomiting na-adịghị egbu mgbu, mgbawa na-agbawa agbawa nke narị milliliters ọbara uhie na-egbuke egbuke ma na-ebu ọnụ ọgụgụ ọnwụ nke pasent 15 ruo 20 n'otu oge ọbara ọgbụgba.
• Mallory-Weiss Tear (5% ruo 15% nke ọbara elu): ogologo oge laceration (anya mmiri) na akpụkpọ ahụ mucous na nkwụsịtụ ebe esophagus na-ezute afọ, na-akpalite site na ** ime ihe ike, ikpo ọkụ, ma ọ bụ vomiting siri ike *** (mgbe mmanya na-egbu egbu, nsị nri, nrịanrịa siri ike na ime ime). Na-amalitekarị site n'ọtụtụ akụkụ nke vomit nkịtị na-esote na mberede na ọbara uhie na-egbuke egbuke.
• Gastritis Erosive, Esophagitis, na Dieulafoy Lesion ***: Na-agbasa ọbara ọgbụgba site na reflux acid siri ike, mmanya na-aba n'anya, nrụgide ọrịa siri ike, ma ọ bụ ọnya ** Dieulafoy ** (nnukwu nnukwu akwara submucosal n'ime afọ nke elu nke na-emebi site na obere ntụpọ mucosal ma na-ebute oke ọnya na-agba ọbara na mberede na-enweghị mgbawa).

2. Mbelata GI na-akpata ọbara ọgbụgba (Colon, Rectum, and Small Bowel)¶

• Ọbara diverticular (Diverticulosis: 30% ruo 50% nke ọbara ọgbụgba dị ala): Obere obere akpa dị ka herniations ( diverticula*) na mgbidi muscular nke eriri afọ, nke na-adịkarị na ndị okenye karịa afọ 50, na-etolite ebe ntinye akwara nri (* vasa recta colon*) na-amapu mgbidi ahụ. Ọ bụrụ na akwara vasa recta dị n'ime diverticulum agbawa, ọ na-ebute ** na mberede, enweghị mgbu na-agafe nnukwu maroon ma ọ bụ ọbara ọbara na-acha uhie uhie na mkịrịkọ* n'ime ụlọ mposi.
• ** Angiodysplasia (Vascular Ectasias): Ndị na-emebi emebi, nke gbagọrọ agbagọ nke capillaries na veins na mgbidi nke eriri afọ aka nri ma ọ bụ obere eriri afọ, nke na-emekarị na ndị toro eto, ndị ọrịa na-arịa ọrịa akụrụ na-adịghị ala ala, ma ọ bụ ndị ọrịa nwere aortic stenosis ( ọrịa Heyde's syndrome**).
• ** Ischemic Colitis, Ọrịa afọ na-efe efe (Ulcerative Colitis / Crohn's Disease), na Ọrịa na-efe efe : N'adịghị ka ọbara ọgbụgba diverticular (nke na-adịkarịghị egbu mgbu), ọnọdụ ndị a na-ebute ** mgbu afọ ntachi nke jikọtara ya na afọ ọsịsa ọbara ma ọ bụ imi.
• **Colorectal Polyps na Colorectal Cancer ***: Ọtụtụ mgbe na-ebute ngwa ngwa, na-adịghị ala ala nke na-eduga na anaemia erughi ígwè, ma ọ bụ eriri uhie gbara ọchịchịrị gbakọtara n'ime akwa stool.
• ** Hemorrhoids na Anal Fissures ***: veins fụrụ akpụ n'ime oghere gbasara ike (hemorrhoid) ma ọ bụ anya mmiri dị nkọ na oghere gbasara ike (fissure, nke dị ka "ịgafe iko agbajiri" n'oge mmegharị afọ) na-eyikarị uwe dị n'èzí stool ma ọ bụ na-agbanye ọbara uhie na-egbuke egbuke na akwụkwọ mposi mgbe ehichapụchara.

Ịghọta ujo hypovolemic: Gịnị kpatara ọbara mgbali elu nkịtị nwere ike ịbụ ụgha¶

Otu onye toro eto na-ejide ihe dị ka ** 5,000 milliliters (lita 5 / 10.5 pint) nke ọbara ***. Mgbe mmadụ na-agbaba n'afọ ma ọ bụ eriri afọ, ahụ na-ewepụta ngwa ngwa nke adrenaline iji gbochie arịa ọbara ma mee ka obi dị ngwa ngwa, nke ** na-eme ka ọbara mgbali systolic na-ele anya dị ka aghụghọ ruo mgbe onye ọrịa tụfuru pasent 30 (1.5) nke ọbara ya ***.

Jiri American College of Surgeons Advanced Trauma Life Support (ATLS) nhazi ọkwa ọbara ọgbụgba iji mata ujo n'oge tupu ọ̀tụ̀tụ̀ ọbara mgbali elu:

Ịdọ aka ná ntị dị mkpa: imeju imeju, ndị na-edozi ọbara, na fistula aortoenteric¶

Ọ bụrụ na onye na-agba ọbara so na nke ọ bụla n'ime otu atọ ndị a nwere nnukwu ihe ize ndụ, gwa 911/112/999 onye na-ezipụ ozi na ndị ọrụ ahụike n'ahịrịokwu mbụ gị:

1. ** Ọrịa imeju amaara ma ọ bụ nke a na-enyo enyo / Cirrhosis (Ọbara Variceal): Chọọ anya/akpụkpọ ahụ na-acha odo odo ( jaundice**), afọ juru fụrụ akpụ (ascites), udide dị ka arịa ọbara uhie n'obi (** udide angiomata**), ma ọ bụ nkwụ na-acha ọbara ọbara (****** nkwụ ọbara). Ọbara ọbara dị iche iche na-achọ intravenous n'ụlọ ọgwụ ozugbo terlipressin ma ọ bụ octreotide (iji belata nrụgide vein portal), prophylactic ** IV ọgwụ nje (ceftriaxone)**, na mberede endoscopic variceal band ligation n'ime awa 12.
2. ** Ndị ọrịa na-ewere Anticoagulants ("Ọbara Thinners") ma ọ bụ Dual Antiplatelet Therapy *: Lelee ma ọ bụrụ na onye ọrịa ahụ na-ewere warfarin (Coumadin), Direct Oral Anticoagulants (apixaban [Eliquis], rivaroxaban [Xarelto], edoxaban [Savaysa], dabigatran [Savaysa], dabigatran () [Plavix], prasugrel, ticagrelor, aspirin). Ngalaba mberede ụlọ ọgwụ na-ebu ụfọdụ ọgwụ mgbochi mgbagha nke intravenous ( 4-factor Prothrombin Complex Concentrate [Kcentra/Beriplex] + IV Vitamin K maka warfarin; ** andenet alfa ** maka apixaban/rivaroxaban; idarucizumab [Praxbind] maka dabigatran nke onye ọrịa ahụ nwere ike ịkwụsị na-egbu egbu ma ọ bụrụ na onye ọrịa ahụ na-egbu ya mgbe otu ọgwụ na-egbu egbu. iloro.
3. ** tupu afọ Aortic Aneurysm (AAA) Graft Surgery ("Herald Bleed" nke Aortoenteric Fistula) ***: Ọ bụrụ na onye nwetụla aka na-emeghe ma ọ bụ endovascular ịwa ahụ nke etinyere na aorta afọ ya na-amalite ** ọ bụla *** na-agbapụta eriri afọ (ọbụlagodi obere, nkwụsị onwe ya ma ọ bụ ihe mberede na-egbu mgbu) ma ọ bụghị ya. Ngwunye aortic synthetic nwere ike jiri nwayọọ nwayọọ na-abanye na mgbidi nke akụkụ atọ dị n'akụkụ duodenum, na-emepụta ** aortoenteric fistula **; A na-esochi obere "ọbara mgbasa ozi" awa ma ọ bụ ụbọchị mgbe e mesịrị site na ọdachi, na-egbu egbu ozugbo site na aorta banye n'ime eriri afọ ọ gwụla ma edoziziri ya n'ime ụlọ ịwa ahụ.

Nleba anya pụrụ iche: GI ụmụaka na-agba ọbara na ntinye batrị bọtịnụ¶

Mgbe nwa ọhụrụ, nwa na-eto eto, ma ọ bụ nwata toro eto na-agbọpụta ọbara ma ọ bụ gafere stool gbara ọchịchịrị ma ọ bụ ọbara, ma ihe kpatara ya na ọnụ ọgụgụ ọbara dị oke egwu dị iche na ndị okenye. N'ihi na ọnụ ọgụgụ ọbara nwatakịrị na-ekesa bụ naanị ** 70 ruo 80 milliliters kwa kilogram nke arọ ahụ ** (nke pụtara kilogram 10 [22 paụnd] dị afọ 1 nwere naanị ** 750 milliliters nke mkpokọta ọbara n'ahụ ha dum **), na-efunahụ naanị 150 ruo 200 milliliters (ihe na-erughị otu iko) nke ọbara na-etinye nwa na-eto eto ngwa ngwa.

• ** Batrị Button Swallowed (Aortoesophageal Fistula Emergency): Ọ bụrụ na nwatakịrị na-agbapụta ọbụna obere ntụpọ ma ọ bụ ogologo nke ọbara ọbara ọbara na-acha ọbara ọbara ma ọ bụ ihe na-acha kọfị, jụọ ozugbo ma ọ bụrụ na ha nwere ike ilo batrị batrị batrị ** lithium coin-cell ** (ọbụlagodi ruo 2 ruo 4 izu gara aga, dị ka ụbọchị mmanya na-egbu egbu n'ime batrị na-eri nri site n'ụbọchị nri abalị site na mmiri ara ehi. mwepụ). Kpọọ 911/112/999 ozugbo ma enyela **enye ihe ọ bụla n'ọnụ ozugbo hematemesis mere.
• ** Intussusception ("Currant Jelly" stools na ụmụ ọhụrụ 3 ọnwa ruo afọ 3): Ọ bụrụ na nwatakịrị ma ọ bụ na-eto eto na-adọta ikpere ha na mberede n'obi ha na-eti mkpu nke ihe mgbu afọ ọ bụla 15 ruo 20 nkeji, na-esote ike ọgwụgwụ, vomiting, na ịgafe ọbara ọbara ọbara, imi jupụtara na ya dị ka ihe mkpuchi. eriri afọ ejirila teliskop n'ime ọzọ (** intussusception**). Nke a na-achọ ngwa ngwa ụlọ ọgwụ mberede ngwa ngwa ultrasound na mbelata ikuku-enema iji gbochie necrosis bowel na perforation.
• Ọbara Nne na-eloda ma ọ bụ Epistaxis (Ọbara imi)**: Mgbe ụfọdụ, nwa amụrụ ọhụrụ na-enye ara na-agbọpụta ọbara ma ọ bụ na-agafe n'oche gbara ọchịchịrị naanị site na ilo ọbara nne site na ọnụ ọnụ ara gbawara agbawa, ma ọ bụ nwa toro eto na-agbọpụta ọbara gbasasịrị kọfị ka ọ losịrị ọbara si n'azụ. imi imi abalị. N'agbanyeghị nke a, dọkịta ga-enyocha nwa ahụ iji wepụ ezi ọbara ọgbụgba mucosal, Meckel's diverticulum (ọbara ọgbụgba na-acha ọbara ọbara na-acha ọbara ọbara n'ime ụmụaka na-eto eto), ma ọ bụ polyps na-eto eto.

Ihe ị ga-atụ anya na ngalaba mberede ụlọ ọgwụ: ọnụọgụ ihe ize ndụ na hemostasis endoscopic¶

Ịmara ihe na-eme ozugbo ụgbọ ihe mberede rutere n'ọnụ ụlọ mberede na-enyere ndị òtù ezinụlọ aka ịnye nkwenye doro anya na akụkọ ihe mere eme ọgwụ:

1. ** ahịrị eriri afọ abụọ buru ibu na mmịnye ọbara na-egbochi ya *: Ndị nọọsụ mberede na-etinye ozugbo ** nnukwu cannulas abụọ na-agba agba (nyocha 16 ma ọ bụ nlele 18) n'ime ogwe aka ma ọ bụ veins antecubital, na-adọta ọbara maka ọnụ ọgụgụ ọbara zuru oke, coagulation panel, fuse blood panel (INR) mmiri mmiri crystalloid (Ringer's lactate ma ọ bụ $0.9% $ saline nkịtị). Nnwale ụlọ ọgwụ nke ọgbara ọhụrụ (nke ACG, ESGE, na UK NICE kwadoro) na-egosi na ọnụ ụzọ mmịnye ọbara ọbara ọbara na-amachibidoro (mmịnye mgbe haemoglobin dara na * 7 ederede g/dL}$ [\(70\text{g/L}\)] n'ọtụtụ ndị ọrịama ọ bụ $ 8\dtext} g/L}$] na ndị ọrịa na-arịa ọrịa obi na-arịa ọrịa obi) na-azọpụta ndụ karịa mmịnye oke mmịnye, n'ihi na mmịnye nke ukwuu na-ebuli ọnụ ụzọ na ọbara mgbali elu ma na-agbapụ mkpụkọ kpụkọrọ akpụkọ ọhụrụ.
2. ** Glasgow-Blatchford Score (GBS) na ọgwụ intravenous : Ndị dọkịta na-agbakọ ** Glasgow-Blatchford Score (iji ọbara urea nitrogen, hemoglobin, ọbara mgbali systolic, pulse rate, melena, syncope, ọrịa imeju, na nkụda mmụọ obi) iji chọpụta ịdị njọ. Ndị ọrịa na-enweta nnukwu doses intravenous ** proton pump inhibitors (dị ka pantoprazole ma ọ bụ esomeprazole)* iji wepụ acid afo ka platelet wee nwee ike imechi, prokinetic erythromycin (nyere 30 ruo 60 nkeji tupu endoscopy iji kpochapụ mkpụkọ ọbara n'ahụ afọ), na **octreotide ma ọ bụ terftripressin plush bụ nke a na-enyo enyo.
3. ** Endoscopic Hemostasis, Interventional Radiology, ma ọ bụ Balloon Tamponade *: N'ime awa 12 ruo 24 (ma ọ bụ ozugbo ikuku ikuku intubation na ndị ọrịa na-akwụghị ụgwọ), onye gastroenterologist na-agafe eriri-optic na-agbanwe agbanwe esophagogastroduodenoscope (EGD) ** ala akpịrị iji chọta arịa ọbara ọgbụgba wee mechie ya site na iji electroagulation. epinephrine injection, hemostatic powder spray (Hemospray), ma ọ bụ elastic variceal roba band ligation . Ọ bụrụ na enweghị ike ịkwụsị ọbara ọgbụgba na endoscopically, ndị na-ahụ maka redio na-eme ihe na-eme ** transcatheter arterial embolization (TAE) (na-etinye microcatheter site na femoral ma ọ bụ radial artery iji gbanye alaka na-agba ọbara na eriri igwe) ma ọ bụ tinye transjugular intrahepatic portosystemic shunt ( TIPS) maka refractory varice.

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• ** American College of Gastroenterology (ACG, United States): ** * ACG Clinical Guideline: Upper Gastrointestinal na Ulcer Bleeding * (Laine et al., * American Journal of Gastroenterology *, 2021) na * ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding * (3., Up20).
• ** European Society of Gastrointestinal Endoscopy (ESGE):** * Ntuziaka ESGE: Nchọpụta Endoscopic na njikwa ọbara ọgbụgba na-adịghị elu nke Gastrointestinal Ọbara * (2021) na Baveno VII Consensus Workshop on Portal hypertension and Variceal Bleeding (2022).
• ** National Institute for Health and Care Excellence (NICE, United Kingdom) na British Society of Gastroenterology (BSG, United Kingdom):** * Nnukwu ọbara ọgbụgba n'ime ihe karịrị 16s: Management (CG141)* na BSG Multisociety Care Bundle for Early Management of Acute Upper GI Bleeding.
• ** American College of Surgeons (ACS, United States):** * Advanced Trauma Life Support (ATLS) Akwụkwọ ntuziaka ụmụ akwụkwọ* (Nhazi nke ihe ịma jijiji Hemorrhagic: Klas I site na IV na Triad nke Hypothermia, Acidosis, na Coagulopathy).

Ntuziaka emetụtara¶

• Nchọpụta ujo na njikwa enyemaka mbụ
• Njikwa ọbara: nrụgide ozugbo, mbukota, na njem nlegharị anya
• Ntụle nkụda mmụọ na syncope
• Nsi nri, nnukwu gastroenteritis, na akpịrị ịkpọ nkụ
• Nọmba mberede na izipu mba ofesi