Goals of Treatment GI bleeding is a common and occasionally life-threatening condition in infants and children An orderly approach to this problem is essential (see Chapter 33 Gastrointestinal Bleeding ) Significant GI bleeding places a patient at risk of circulatory collapse The goal for the ED provider is to address lifethreatening GI bleeding by stopping the ongoing losses and replacing intravascular volume Addressing ongoing bleeding will require a team of professionals that may include the emergency physician, hospitalist, surgeon, gastroenterologist, hematologist, and interventional radiologist Addressing potential circulatory compromise achieves two principal objectives: Oxygencarrying capacity is improved through administration of blood products and the perfusion pressure to vital organs is preserved via blood product and intravenous (IV) fluid administration The vast majority of patients with either upper or lower GI bleeding will not have experienced significant blood loss These patients can be managed successfully with judicious laboratory investigation, supportive care, and follow-up with a primary care provider or an appropriate subspecialist UPPER GASTROINTESTINAL BLEEDING Esophageal Varices Goals of Treatment The initial goals of therapy of suspected variceal hemorrhage are identical to those of massive upper GI bleeding from any source Volume resuscitation to maintain adequate perfusion and oxygen-carrying capacity is necessary, but overexpansion of the intravascular volume should be avoided because it may contribute to rebleeding Patients with actively bleeding esophageal varices (EV) may also have liver dysfunction and, as a result, early therapy should also correct existing coagulopathies CLINICAL PEARLS AND PITFALLS