Upper Gastrointestinal Bleeding - Diagnosis and Management
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Upper Gastrointestinal Bleeding - Diagnosis and Management

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Upper gastrointestinal bleeding is a fatal condition, if not tackle in time. Causes, diagnosis and management are being discussed in the presentation.

Upper gastrointestinal bleeding is a fatal condition, if not tackle in time. Causes, diagnosis and management are being discussed in the presentation.

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Upper Gastrointestinal Bleeding - Diagnosis and Management Upper Gastrointestinal Bleeding - Diagnosis and Management Presentation Transcript

  • Dr Praveen Kumar
  • Definition  Bleeding proximal to the ligament of trietze
  • Anatomy
  • Presentation  Haematemesis  Malena  Haematochezia  Anemia  Fecal Occult Blood
  • Natural History  75% of cases will stop spontaneously  25% Will  Require surgery  Develop complications  Die Amount and Rate of Bleeding
  • Common Causes  Peptic ulcer  Duodenal ulcer  Gastric ulcer  Gastritis  Oesophagitis  Mallory – Weiss syndrome  Esophageal varices
  • Uncommon Causes  Gastric carcinoma  Pancreatitis  Haemobilia  Duodenal diverticulum
  • Immediate Management  Airway + Oxygen  Breathing  Circulation  Ng Tube?  Catheter?
  • Lab Investigations  FBC U&E  Clotting  Cross match
  • History  Mode of bleeding  Rate  Duration  Frequency  Co-morbidities  Bleeding tendencies  Drugs,warfarin,NSAID,
  • Examination  Physical exam  Clinical diagnosis of the cause is possible in 60% of cases
  • Assessment of the blood loss Estimated fluid and blood losses for 70 kg man CLASS 1 CLASS 2 CLASS 3 CLASS 4 Blood loss 750 -15% 750-1500 25-30% 1500-2000 30-40% >2000 >40% Pulse rate <100 >100 >120 >140 BP N N D D Pulse pressure N D D D RR 14-20 20-30 30-40 >35 UOP >30 20-30 5-15 Negligible CNS/MENTAL Slightly Anxious Mildly Anx Anx/conf Conf/leth Fluid replacement Crystalloid Crystalloid Cryst/blood Cryst/blood
  • Investigations  Endoscopy: OGD, Colonoscopy,enteroscopy  Construct study  CT – Scan  Angiography
  • Gastroscopy  Endoscopy should be done within 24 H  Adrenaline injection  Heat probe  Argon plasma coagulation
  • Surgery For uncontrollable bleeding by endoscopy (Severe upper GIT bleeding)
  • Risk Factors  Shock on presentation  Hb < 8 gm  Age > 60 Y  Gastric ulcer  Rebleeding  Spurting vessel  Deficiency of blood
  • Endoscopic erosive gastritis
  • Gastritis produced by aspirin and other nonsteroidal antiinflammatory drugs
  • Benign gastric ulcer
  • Duodenal ulcer
  • Cardia carcinoma
  • Mallory-Weiss tear
  • Two ulcers in the mid oesophagus
  • Large esophageal varices
  • Thanks