ZyraDoc #24 - August 25, 2026

A 55-year-old man with a history of liver cirrhosis presents with acute hematemesis, melena, lightheadedness, and tachycardia.

His blood pressure is 88/54 mmHg, HR is 118 bpm, and lab work reveals hemoglobin of 6.8 g/dL.

While setting up two large-bore IV lines and starting IV fluid resuscitation, the resident suggests administering oral PPIs and holding IV vasoactive medications until after endoscopy.

Case Summary

Clinical Focus:

A 55-year-old cirrhotic male presents with acute upper gastrointestinal bleeding and hemorrhagic shock, suspicious for acute esophageal variceal rupture.

Diagnostic Features of Variceal Upper GI Bleed:

Hematemesis (bright red blood or 'coffee-ground' emesis) and melena
Hemodynamic instability (hypotension, tachycardia, hypoperfusion)
History of chronic liver disease, cirrhosis, portal hypertension, or stigmata of liver failure

Acute upper GI bleeding in cirrhosis requires immediate resuscitation, prophylactic antibiotics, IV vasoactive infusions, and urgent endoscopy.

Here is the Management Strategy:

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