Aetiology of upper gi bleed

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Aetiology of upper gi bleed

  1. 1. UPPER GI BLEED
  2. 2. AETIOLOGY
  3. 3. PEPTIC ULCER • Breaks in the mucosal surface >5 mm • 2 types- • Duodenal Ulcers • Gastric Ulcers • NSAIDS H.Pylori PEPTIC ULCER
  4. 4. GASTRIC EROSIONS • GASTRITIS • Alcohol intake • NSAID use • Stress
  5. 5. ESOPHAGITIS• Inflammation of esophageal mucosaa) GERDb) Barret Esophagusc) Chemical Esophagitis- alcohol,acids,alkalisd) Infectious esophagitis- HSV,CMV,fungal
  6. 6. Mallory-Weiss tear • Longitudinal tears • Alcoholics • Symptoms : • Vomiting • retching HEAMATEMESIS • Coughing
  7. 7. ESOPHAGEAL VARICES • Liver diseases– Cirrhosis • Portal Hypertension
  8. 8. NEOPLASMS • Ca.esophagus- Squamous cell Ca Adeno Ca • Ca.stomach-Second most common Tumor
  9. 9. LESS COMMON CAUSES• Vascular Malformations Hereditary hemorrhagic telangiectasias• Aorto-duodenal Fistula• Hemosuccus pancreaticus Bleeding from the bile duct or pancreatic duct
  10. 10. CLINICALPRESENTATION
  11. 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. 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. 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. 14. iv. Carcinoma stomachv. chronic duodenal ulcervi. Mallory Weiss syndromeLESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia
  15. 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. 16. Mallory – Weiss tear-patient vomits several timesfresh blood only appearsafter the initial vomit
  17. 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. 18. • Slower upper GI bleeding- mixing of blood with gastric juicedarker, like that of ground coffee
  19. 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. 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. 21. • Causes – all the causes of haematemesis may produce melaena• Rarely, swallowed blood give rise to melaena: epistaxis
  22. 22. Thank you...

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