Upper Gastro-Intestinal Bleeding
Upcoming SlideShare
Loading in...5
×
 

Upper Gastro-Intestinal Bleeding

on

  • 7,164 views

This presentation was prepared for undergraduate medical student of angladesh.

This presentation was prepared for undergraduate medical student of angladesh.

Statistics

Views

Total Views
7,164
Views on SlideShare
7,156
Embed Views
8

Actions

Likes
1
Downloads
413
Comments
1

2 Embeds 8

http://www.slideshare.net 7
https://twitter.com 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Upper Gastro-Intestinal Bleeding Upper Gastro-Intestinal Bleeding Presentation Transcript

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