Hemodynamically stable, no signs of active bleeding Melena/Hematemesis Hemodynamically stable, no signs of active bleeding Start Pantoprazole 40mg IV BID, add Octreotide/abx in cirrhosis* Resuscitate, check coags Can call GI in AM if overnight admission Hemodynamically unstable, active bleeding GI consult *Antibiotics are indicated in actively bleeding cirrhosis with ascites. Note, there is no role for FOBT testing. These protocols do not replace clinical judgment. When in doubt, call GI.

Note, there is no role for FOBT testing. Always use clinical judgment. Hematochezia/Bright red blood per rectum Colonoscopy with polypectomy in the past 1-3 months GI consult Hemodynamically stable Active bleeding GI consult and consider Tagged RBC scan No active bleeding Hemodynamically unstable NG Lavage Positive (blood after 500cc of lavage solution = RAPID upper GI bleed. Start IV PPI and Octreotide/abx* in cirrhosis. Resuscitate, ICU and GI consults. Negative ICU and GI consults *Antibiotics are indicated in actively bleeding cirrhosis with ascites. Note, there is no role for FOBT testing. Always use clinical judgment.

Transfuse to get Hb >7-8 mg/dL, check coags Mild anemia Hb around 7-11mg/dL Non-urgent GI consult Severe anemia Hb <7mg/dL Transfuse to get Hb >7-8 mg/dL, check coags Note, there is no role for FOBT testing in this algorithm.

Normal liver associated enzymes Abdominal pain Normal liver associated enzymes GI consult Abnormal liver enzymes RUQ US Stones and normal bile ducts Surgical consult Stones and dilated bile ducts MRCP Positive for bile duct stone Negative for bile duct stone Negative for stones or dilated bile ducts