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.
    • 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.
  • 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.
    • 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.
  • 8.
    • 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.
  • 9.
    • 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.
  • 10.
    • 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.
  • 11.
    • 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.
  • 12.
    • 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.
  • 13.
      • 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.
  • 14.
    • 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..
  • 15.
    • 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
  • 16.
    • 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
  • 17.