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Version Date from Date to Amendment 
2.1 Nov 2017 Nov 2019 Removed all RGH details 



Southern Adelaide Local Health Network (SALHN) 

Haematemesis and Melaena 


Information Required  
  Focal gastrointestinal symptoms 
  Medications (antiplatelets, anticoagulation, NSAIDs) 
  Prior gastrointestinal surgery 

Investigations Required  

Fax Referrals to 
  Gastroenterology Outpatient Clinic 

Flinders Medical Centre 8204 5555 



Red Flags 
 Significant drop in postural BP (?20mmHg systolic, ?10mmHg diastolic) 
 Definite melaena 
 Hb &lt; 100gm/L 


Suggested GP Management 
Assess for significant drop in postural BP (?20mmHg 
systolic, ?10mmHg diastolic) which indicates 
haemodynamic instability 

Acute (haemodynamically unstable) 
  Intravenous fluid resuscitation 
  Keep patient fasted 
  Ambulance transfer to Flinders Medical Centre 

Emergency Department 
  Notify luminal Gastroenterology registrar on 8204 

5511 pager #38009 

Non-acute (haemodynamically stable) 
  Check FBE 
  Refer to Flinders Medical Centre Emergency 

Department and notify Gastroenterology Registrar on 
8204 5511 pager #38009 if 
o Definite melaena 
o Hb &lt;100gm/L or symptomatic  
o Age &gt;60yrs or history of significant comorbidity 
o Anticoagulated 


If Hb &gt;100gm/L and asymptomatic 
  Commence empirical proton pump inhibitor and 

refer urgently to Gastroenterology clinic 

Clinical Resources 
  Wee E. Management of nonvariceal upper 

gastrointestinal bleeding. J Postgrad Med [serial 
online] 2011 [cited 2014 Oct 20];57:161-7. Available 
from: http://www.jpgmonline.com/text.asp?2011/57/


Patient Information 
  UpToDate Patient information: GI bleed (The Basics)  



General Information to assist with referrals and the and Referral templates for FMC are available to download from the SAHN Outpatient Services 
website www.sahealth.sa.gov.au/SALHNoutpatients