Upper GI Bleeding Medical Slides

Emphasize the restrictive transfusion threshold of hemoglobin 7 g/dL for most patients, supported by the TRIGGER and Villanueva trials showing improved survival compared to liberal transfusion. Note exceptions: active massive hemorrhage with hemodynamic instability, acute coronary syndrome (target 8-9 g/dL), and initial hemoglobin that may not reflect true blood loss in acute bleeding.

Present the evidence for early endoscopy within 24 hours for all patients and within 12 hours for high-risk patients (hemodynamic instability, bloody nasogastric aspirate, Glasgow-Blatchford score above 12). Discuss why urgent endoscopy within 6 hours has not shown additional benefit in most studies, including the 2020 Lau trial, except in suspected variceal bleeding.

Create a branching algorithm slide: if cirrhosis or portal hypertension is known or suspected, initiate variceal protocols (IV octreotide, IV ceftriaxone, restrictive transfusion, urgent endoscopy with band ligation). Highlight clinical clues suggesting varices including splenomegaly, ascites, spider angiomata, and thrombocytopenia, which should trigger empiric variceal management even before endoscopy confirms the source.