Aetiology of upper gi bleed

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  • 1. UPPER GI BLEED
  • 2. AETIOLOGY
  • 3. PEPTIC ULCER • Breaks in the mucosal surface >5 mm • 2 types- • Duodenal Ulcers • Gastric Ulcers • NSAIDS H.Pylori PEPTIC ULCER
  • 4. GASTRIC EROSIONS • GASTRITIS • Alcohol intake • NSAID use • Stress
  • 5. ESOPHAGITIS• Inflammation of esophageal mucosaa) GERDb) Barret Esophagusc) Chemical Esophagitis- alcohol,acids,alkalisd) Infectious esophagitis- HSV,CMV,fungal
  • 6. Mallory-Weiss tear • Longitudinal tears • Alcoholics • Symptoms : • Vomiting • retching HEAMATEMESIS • Coughing
  • 7. ESOPHAGEAL VARICES • Liver diseases– Cirrhosis • Portal Hypertension
  • 8. NEOPLASMS • Ca.esophagus- Squamous cell Ca Adeno Ca • Ca.stomach-Second most common Tumor
  • 9. LESS COMMON CAUSES• Vascular Malformations Hereditary hemorrhagic telangiectasias• Aorto-duodenal Fistula• Hemosuccus pancreaticus Bleeding from the bile duct or pancreatic duct
  • 10. CLINICALPRESENTATION
  • 11. Bleeding - present in 5 ways.1. Hematemesis - red blood or "coffee-ground" material.2. Melena - black, tarry, foul-smelling stool.3. Hematochezia - passage of bright red or maroon blood from the rectum.
  • 12. 4. Occult GI bleeding – absence of overt bleeding fecal occult blood test - +ve presence of iron deficiency.5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea.
  • 13. I. HAEMATEMESIS• vomiting of blood follows bleeding from esophagus ,stomach and duodenum( above the duodenal flexure) COMMON CAUSESi. Ruptured oesophageal varicesii. Esophageal carcinomaiii. Chronic gastric ulcer
  • 14. iv. Carcinoma stomachv. chronic duodenal ulcervi. Mallory Weiss syndromeLESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia
  • 15. • If the source of bleeding is above gastro-oesophageal sphincter ( eg : oesophageal varices) fresh blood wells up in mouth than being actively vomited
  • 16. Mallory – Weiss tear-patient vomits several timesfresh blood only appearsafter the initial vomit
  • 17. • Sudden loss of > 20% -tachycardia , hypotension, faintness and sweating• Brisk hematemesis -from large vessel in an ulcer BRIGHT RED• Bright red blood –naso or oro pharynx
  • 18. • Slower upper GI bleeding- mixing of blood with gastric juicedarker, like that of ground coffee
  • 19. II. MELAENA - black , tarry stools containing occult blood -Upper GI bleeding -Haemorrhage from right side of colon -appx 60 ml of blood - single black coloured stool
  • 20. Blood for 14 hrs in the GI tract• Characteristicsi. Black tarry stool- due to production of acid haematinii. Offensive odour - acid haematin is altered by bacteriaiii. Semisolid in consistencyiv. Usually associated with vertigo , dizziness, syncopal attack during defecation
  • 21. • Causes – all the causes of haematemesis may produce melaena• Rarely, swallowed blood give rise to melaena: epistaxis
  • 22. Thank you...