| What does the abbreviation APC stand for? | Argon plasma coagulation | Hemodynamically stable Heart rate <90/min Patient is conscious No bleeding for at least the past 72 hours (as indicated by no further fall in hemoglobin) APC: Argon plasma coagulation EVL: Endoscopic variceal ligation GI: Gastrointestinal H. pylori: Helicobacter pylori LFT: Liver function test NSAIDs: Non-steroidal anti-inflammatory drugs PPI: Proton pump inhibitor TIPS: Transjugular intrahepatic portosystemic shunt USG: Ultrasonography TREATMENT AT DISCHARGE TREATMENT AT DISCHARGE | 159 | definition | 0.900 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | Hemodynamically stable Heart rate <90/min Patient is conscious No bleeding for at least the past 72 hours (as indicated by no further fall in hemoglobin) APC: Argon plasma coagulation EVL: Endoscopic variceal ligation GI: Gastrointestinal H. | 1 | page=1,block=41 | 0.700 | valid |
| What does the abbreviation EVL stand for? | Endoscopic variceal ligation | Hemodynamically stable Heart rate <90/min Patient is conscious No bleeding for at least the past 72 hours (as indicated by no further fall in hemoglobin) APC: Argon plasma coagulation EVL: Endoscopic variceal ligation GI: Gastrointestinal H. pylori: Helicobacter pylori LFT: Liver function test NSAIDs: Non-steroidal anti-inflammatory drugs PPI: Proton pump inhibitor TIPS: Transjugular intrahepatic portosystemic shunt USG: Ultrasonography TREATMENT AT DISCHARGE TREATMENT AT DISCHARGE | 189 | definition | 0.900 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | Hemodynamically stable Heart rate <90/min Patient is conscious No bleeding for at least the past 72 hours (as indicated by no further fall in hemoglobin) APC: Argon plasma coagulation EVL: Endoscopic variceal ligation GI: Gastrointestinal H. | 1 | page=1,block=41 | 0.700 | valid |
| What does the abbreviation TIPS stand for? | Transjugular intrahepatic portosystemic shunt | Hemodynamically stable Heart rate <90/min Patient is conscious No bleeding for at least the past 72 hours (as indicated by no further fall in hemoglobin) APC: Argon plasma coagulation EVL: Endoscopic variceal ligation GI: Gastrointestinal H. pylori: Helicobacter pylori LFT: Liver function test NSAIDs: Non-steroidal anti-inflammatory drugs PPI: Proton pump inhibitor TIPS: Transjugular intrahepatic portosystemic shunt USG: Ultrasonography TREATMENT AT DISCHARGE TREATMENT AT DISCHARGE | 374 | definition | 0.900 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | pylori: Helicobacter pylori LFT: Liver function test NSAIDs: Non-steroidal anti-inflammatory drugs PPI: Proton pump inhibitor TIPS: Transjugular intrahepatic portosystemic shunt USG: Ultrasonography TREATMENT AT DISCHARGE TREATMENT AT DISCHARGE | 1 | page=1,block=41 | 0.700 | valid |
| What items are listed under “RESTARTING OF ANTI PLATELETS/ ANTICOAGULANTS (IF INDICATED)”? | • After control of bleed: resume low dose Aspirin on day 1 • Other antiplatelets/ anticoagulants may be resumed by day 3-5 • Consultation with cardiologist should be taken | RESTARTING OF ANTI PLATELETS/ ANTICOAGULANTS (IF INDICATED)
• After control of bleed: resume low dose Aspirin on day 1 • Other antiplatelets/ anticoagulants may be resumed by day 3-5 • Consultation with cardiologist should be taken | 60 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | • After control of bleed: resume low dose Aspirin on day 1 • Other antiplatelets/ anticoagulants may be resumed by day 3-5 • Consultation with cardiologist should be taken | 1 | page=1,block=10 | 0.700 | valid |
| What is the initial dosage and frequency of Propranolol for achieving a target heart rate? | Propranolol (20 mg) 12 hourly | Propranolol (20 mg) 12 hourly, increase incrementally to achieve a heart rate of 60/min unless contraindicated Repeat endoscopy and H. pylori testing at 4- 6 weeks and appropriate treatment Pantoprazole/ Omeprazole (40 mg) twice a day for 4 weeks. Reconsider need for NSAIDs | 0 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | Propranolol (20 mg) 12 hourly, increase incrementally to achieve a heart rate of 60/min unless contraindicated Repeat endoscopy and H. | 1 | page=1,block=18 | 0.700 | valid |
| What is the recommendation for rebleeding after initial endotherapy? | Try another attempt to control with endotherapy | Failure to control bleeding: Refer to higher centre where surgical treatment is available If rebleeding: Try another attempt to control with endotherapy Do relook endoscopy after 24 hours if index endoscopy showed active bleeding and if the endoscopic hemostasis was inadequate Continue PPI infusion for 72 hours If unidentified source on UGIE and colonoscopy, refer to higher centre Rebleeding: Refer to a centre with surgery/ angiography Continue I.V. antibiotics for 5 days or longer depending on the nature of infection Recommendations for transfusion: • Consider in case of active bleeding • Transfuse platelets if platelet count is <50000/ mm3 In case of rebleeding: Try another attempt to control with endotherapy Continue vasoactive drugs for total of 5 days in patients with: • Active bleeding on endoscopy • Patients who are Child-Pugh class C status • Received >4 packed red cell transfusions • LFT and viral markers • USG abdomen • Try to ascertain the etiology of portal hypertension Failure to control bleeding: Fully covered large bore esophageal metal stent or TIPS Plan for long term care of patients for underlying liver disease Repeat endoscopy and assessment for EVL after 2 weeks, continue EVL every 2 to 3 weekly till varices are eradicated. | 105 | factual |
| What is the recommended duration for continuing vasoactive drugs in patients with active bleeding on endoscopy? | for total of 5 days | Failure to control bleeding: Refer to higher centre where surgical treatment is available If rebleeding: Try another attempt to control with endotherapy Do relook endoscopy after 24 hours if index endoscopy showed active bleeding and if the endoscopic hemostasis was inadequate Continue PPI infusion for 72 hours If unidentified source on UGIE and colonoscopy, refer to higher centre Rebleeding: Refer to a centre with surgery/ angiography Continue I.V. antibiotics for 5 days or longer depending on the nature of infection Recommendations for transfusion: • Consider in case of active bleeding • Transfuse platelets if platelet count is <50000/ mm3 In case of rebleeding: Try another attempt to control with endotherapy Continue vasoactive drugs for total of 5 days in patients with: • Active bleeding on endoscopy • Patients who are Child-Pugh class C status • Received >4 packed red cell transfusions • LFT and viral markers • USG abdomen • Try to ascertain the etiology of portal hypertension Failure to control bleeding: Fully covered large bore esophageal metal stent or TIPS Plan for long term care of patients for underlying liver disease Repeat endoscopy and assessment for EVL after 2 weeks, continue EVL every 2 to 3 weekly till varices are eradicated. | 747 | factual |
| What is the recommended duration for oral antibiotics in case of infectious etiology? | a total of 10-14 days | • After control of bleed: resume low dose Aspirin on day 1 • Other antiplatelets/ anticoagulants may be resumed by day 3-5 • Consultation with cardiologist should be taken In case of infectious etiology continue oral antibiotics for a total of 10-14 days IF ACTIVE LOWER GI BLEEDING: • After stabilisation, if facility for colonoscopy available: • Prepare bowel with polyethylene glycol solution before colonoscopy • Hemostasis can be achieved as in UGI bleeding • If colonoscopy is normal, consider small bowel evaluation • If facility for colonoscopy not available: • Stabilise & refer to a centre with facility for surgery and colonoscopy | 233 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567564_gastrointestinal_bleed_part_b.pdf | • After control of bleed: resume low dose Aspirin on day 1 • Other antiplatelets/ anticoagulants may be resumed by day 3-5 • Consultation with cardiologist should be taken In case of infectious etiology continue oral antibiotics for a total of 10-14 days IF ACTIVE LOWER GI BLEEDING: • After stabilisation, if facility for colonoscopy available: • Prepare bowel with polyethylene glycol solution before colonoscopy • Hemostasis can be achieved as in UGI bleeding • If colonoscopy is normal, consider small bowel evaluation • If facility for colonoscopy not available: • Stabilise & refer to a centre |
| What should be continued for 72 hours in case of inadequate endoscopic hemostasis? | Continue PPI infusion for 72 hours | Failure to control bleeding: Refer to higher centre where surgical treatment is available If rebleeding: Try another attempt to control with endotherapy Do relook endoscopy after 24 hours if index endoscopy showed active bleeding and if the endoscopic hemostasis was inadequate Continue PPI infusion for 72 hours If unidentified source on UGIE and colonoscopy, refer to higher centre Rebleeding: Refer to a centre with surgery/ angiography Continue I.V. antibiotics for 5 days or longer depending on the nature of infection Recommendations for transfusion: • Consider in case of active bleeding • Transfuse platelets if platelet count is <50000/ mm3 In case of rebleeding: Try another attempt to control with endotherapy Continue vasoactive drugs for total of 5 days in patients with: • Active bleeding on endoscopy • Patients who are Child-Pugh class C status • Received >4 packed red cell transfusions • LFT and viral markers • USG abdomen • Try to ascertain the etiology of portal hypertension Failure to control bleeding: Fully covered large bore esophageal metal stent or TIPS Plan for long term care of patients for underlying liver disease Repeat endoscopy and assessment for EVL after 2 weeks, continue EVL every 2 to 3 weekly till varices are eradicated. | 278 | factual |
| What should be done if bleeding cannot be controlled? | Refer to higher centre where surgical treatment is available | Failure to control bleeding: Refer to higher centre where surgical treatment is available If rebleeding: Try another attempt to control with endotherapy Do relook endoscopy after 24 hours if index endoscopy showed active bleeding and if the endoscopic hemostasis was inadequate Continue PPI infusion for 72 hours If unidentified source on UGIE and colonoscopy, refer to higher centre Rebleeding: Refer to a centre with surgery/ angiography Continue I.V. antibiotics for 5 days or longer depending on the nature of infection Recommendations for transfusion: • Consider in case of active bleeding • Transfuse platelets if platelet count is <50000/ mm3 In case of rebleeding: Try another attempt to control with endotherapy Continue vasoactive drugs for total of 5 days in patients with: • Active bleeding on endoscopy • Patients who are Child-Pugh class C status • Received >4 packed red cell transfusions • LFT and viral markers • USG abdomen • Try to ascertain the etiology of portal hypertension Failure to control bleeding: Fully covered large bore esophageal metal stent or TIPS Plan for long term care of patients for underlying liver disease Repeat endoscopy and assessment for EVL after 2 weeks, continue EVL every 2 to 3 weekly till varices are eradicated. | 29 | factual |