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Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
Upper Gastro-Intestinal Bleeding
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Upper Gastro-Intestinal Bleeding

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This presentation was prepared for undergraduate medical student of angladesh.

This presentation was prepared for undergraduate medical student of angladesh.

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  • 1. UPPER GASTROINTESTINAL HEMORRHAGE Prof. Feroze Quader Dept. of Surgery BKZMC
  • 2. <ul><li>Upper GIT Hemorrhage is a very frequent medical problem. </li></ul><ul><li>Bleeding Peptic ulcer, Portal hypertension, Gastritis and Oesophageal varices are the common causes for hemorrhage. </li></ul><ul><li>Hematemesis or melena is usually present unless rate of bleeding is minimum. </li></ul><ul><li>Acute bleeding stops spontaneously is 75 % cases. </li></ul><ul><li>Rest of the patient requires surgery or die out of complications. </li></ul>
  • 3. Incidence % Common causes Peptic Ulcer 45 Dudenal ulcer Gastric ulcer Esophageal varices 20 Gastritis 20 Mallory-Weiss syndrome 10 Uncommon causes 5 Gastric Carcinoma Esophagitis Pancreatitis Hemobilia Duodenal diverticulum
  • 4. Gastric Ulcer Duodenal Ulcer Ca-Stomach
  • 5. Esophageal varices Gastritis
  • 6. Mallory-Weiss Tear
  • 7. <ul><li>Hematemesis </li></ul><ul><li>Vomiting of blood is common when bleeding originates from Stomach or esophagus. Color of the vomitus will be </li></ul><ul><li>coffee- ground when gastric acid converts hemoglobin into methemoglobin. </li></ul><ul><li>Melena </li></ul><ul><li>Passage of black tarry stools are common when there is bleeding from any part of Upper GIT. </li></ul><ul><li>The black color of melenic stools is caused by Hematin ,the product of oxidation of Haem by intestinal and bacterial enzymes. </li></ul>
  • 8. <ul><li>Hematochezia </li></ul><ul><li>It is defined as passage of bright-red blood from the ractum. </li></ul><ul><li>Common in bleeding from Colon, Rectum and Anus. </li></ul><ul><li>In case of brisk bleeding in the Upper GIT, Bright red blood may come out unchanged in the stool. </li></ul>
  • 9. <ul><li>Initial assessment and management goals : </li></ul><ul><ul><li>Assessment of the status of the circulatory system and replace blood loss as necessary. </li></ul></ul><ul><ul><li>Determine the amount and rate of bleeding. </li></ul></ul><ul><ul><li>Slow or stop the bleeding by ice-water lavage </li></ul></ul><ul><ul><li>Discover the lesion responsible for the episodes. </li></ul></ul><ul><ul><li>Specific management for underlying causes. </li></ul></ul>
  • 10. <ul><li>Patient may have h/o weakness, dizziness, syncope associated with Hematemesis, melena and hematochezia. </li></ul><ul><li>Patients may have a history of previous dyspepsia, ulcer disease, early satiety, and NSAIDs use. </li></ul><ul><li>Smoking and alcohol may have some association. </li></ul>
  • 11. <ul><li>The goal of the patient's physical examination is to evaluate for shock and blood loss. </li></ul><ul><li>signs of shock include cool extremities, oliguria, chest pain, pre-syncope, confusion, and delirium. </li></ul><ul><li>Hematemesis and melena should be noted. </li></ul>
  • 12. <ul><li>Signs of chronic liver disease should be noted, including </li></ul><ul><ul><ul><li>spider angiomata, </li></ul></ul></ul><ul><ul><ul><li>gynecomastia, </li></ul></ul></ul><ul><ul><ul><li>splenomegaly, </li></ul></ul></ul><ul><ul><ul><li>ascites, </li></ul></ul></ul><ul><ul><ul><li>pedal edema </li></ul></ul></ul><ul><ul><li>Signs of tumor are uncommon but indicate a poor prognosis. Signs include a nodular liver, abdominal mass, and enlarged and firm lymph nodes. </li></ul></ul>
  • 13. <ul><ul><li>Blood grouping and Rh typing and cross matching. </li></ul></ul><ul><ul><li>Upper gastrointestinal endoscopy : </li></ul></ul><ul><ul><ul><li>In case of massive bleeding Endoscopy should be carried out by an experienced operator as soon as the patient is resuscitated. </li></ul></ul></ul><ul><ul><ul><li>For patient with mild bleeding, endoscopy should be carried out on the next morning after admission. </li></ul></ul></ul><ul><ul><li>Occult Blood Test: </li></ul></ul><ul><ul><ul><li>Normally 2.5 blood is lost per day. </li></ul></ul></ul><ul><ul><ul><li>Blood loss between 50-100 ml /day will produce melaena. </li></ul></ul></ul><ul><ul><ul><li>OBT detects amount between 10-50 mL/d. </li></ul></ul></ul>
  • 14. <ul><li>Specific treatment : </li></ul><ul><ul><ul><li>Peptic Ulcers: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Endoscopic hemostastasis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Medical management by H2 antagonist or PIP </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Surgical treatment </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Esophageal varices: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Endoscopic control by electro-coagulation or injection </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Medical treatment for Portal hypertension.. </li></ul></ul></ul></ul></ul>
  • 15. <ul><li>Specific treatment : </li></ul><ul><ul><ul><li>Gastric erosions: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Endoscopic hemostastasis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Medical management by H2 antagonist or PIP </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Surgical treatment </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Mallory-Weiss Tear: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Endoscopic treatment </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>If fails, gastrostomy and repair of the tear. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Malignancy: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Should be treated appropriately </li></ul></ul></ul></ul></ul>
  • 16. <ul><li>Endoscopic hemostastasis </li></ul><ul><li>Medical management by H2 antagonist or PIP </li></ul><ul><li>Surgical treatment </li></ul><ul><li>Endoscopic control by electro-coagulation or injection </li></ul><ul><li>Medical treatment for Portal hypertension. </li></ul><ul><li>Endoscopic treatment </li></ul><ul><li>If fails, gastrostomy and repair of the tear. </li></ul>Should be treated appropriately <ul><li>Endoscopic hemostastasis </li></ul><ul><li>Medical management by H2 antagonist or PIP </li></ul><ul><li>Surgical treatment </li></ul>
  • 17.  

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