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| ==Management of Patients With Ulcer Bleeding ==
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| === '''Initial assessment and risk stratificatio'''n : ===
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| {| class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' 1. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed (Strong recommendation).
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| ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki>
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| |}
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| {| class="wikitable"
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| | colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| | bgcolor="LemonChiffon" |1.Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation)
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| 2. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as the timing of endoscopy, time of discharge, and level of care (Conditional recommendation).
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| 3. Discharge from the emergency department without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2 mg / dl; hemoglobin ≥ 13.0 g / dl for men (12.0 g / dl for women), systolic blood pressure ≥ 110 mm Hg; pulse 100 beats / min; and absence of melena, syncope, cardiac failure, and liver disease, as they have <1 % chance of requiring intervention (Conditional recommendation''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''"
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| ===Laboratory Findings===
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| *Laboratory findings consistent with the diagnosis of Glycogen storage disease type VI include:
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| **Serum triglycerides, cholesterol, and liver transaminases are slightly increased.
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| **Creatine kinase is normal.
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| **Uric acid and lactic acid is normal.
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| **Glucose does not increase following glucagon administration confirms hypoglycemia.
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| '''Fasting test''':
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| *The blood glucose level is assessed after 3-5 hour of fasting, mild hypoglycemia is noticed.
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| *The urine ketones and serum ketone bodies (eg, acetoacetate, beta-hydroxybutyrate) after few hours of fasting is raised.
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| '''Enzyme activity assay''':
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| *Assay of hepatic glycogen phosphorylase enzyme activity can be performed on erythrocytes, leukocytes, and liver cells.
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| Molecular genetic testing is done under the following conditions :
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| *Children with hepatomegaly and ketotic hypoglycemia.
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| *Children with unexplained hepatomegaly with a mild-moderate elevation of transaminase concentrations should have a fasting glucose and ketones check.
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| Liver biopsy is reserved for those in whom the diagnosis cannot be confirmed by molecular genetic techniques.
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