1. 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.

2. 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.

3. 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.

4. 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