Suspected variceal hemorrhage

First, place 2 large-bore IV catheters:
Volume resuscitation
IV octreotide
Antibiotics

Then do urgent endoscopic therapy of esophageal varices:
If no further bleeding:
Initiate secondary prophylaxis → beta blocker + endoscopic band ligation 1-2 weeks later
If continued bleeding → balloon tamponade (temporary) → TIPS (transjugular intrahepatic porto- systemic shunt) or shunt surgery
If it stops but there’s early rebleeding → repeat endoscopic therapy
If recurrent hemorrhage → TIPS or shunt surgery

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