basic outline for evaluation and management of upper gastrointestinal (GI) bleeding.

1. Evaluation of
Upper Gastrointestinal
Bleed

2. Anatomy
• Upper Gastrointestinal tract is proximal to ligament
of Treitz.

3. Common causes :
Oesophageal : Gastric : Duodeal :
Oesophageal varices Gastric ulcer Ulcer
Oesophagitis Gastric cancers Vascular malformation
(Aorto-entric fistulae)
oesophageal cancer Gastritis Hemobilia
Mallory-Weiss tear Gastric varices Hemosuccus pancreaticus

5. Common causes :

6. types :
• VARICEAL BLEEDING
• NON VARICEAL BLEEDING

7. Clinical presentation
• Hematemesis
• Melena
• Hematochezia
• Occult GI bleeding
• Anaemia
• Shock

9. Approach :
• Initial assessment and
resuscitation.
• History - Alcoholism, drugs,
weight loss, anorexia.
• Physical examination +
Signs of liver cell failure
• Investigations
• Diagnosis
• Treatment

10. Clinical presentation
• History

11. Lab investigations :
• CBC- Hb, Platelet count.
• PCV
• Coagulation profile
• Serum electrolytes
• BUN/creatinine ratio ≥ 30
• Blood grouping and cross match

12. Lab investigations :
• ECG
• Stool routine (occult blood)
• HIV, HbsAg, Anti HCV
• RFT
• LFT
• Gastrin levels

13. Endoscopy
• Esophagogastroduodenoscopy (EGD)*
• Video capsule endoscopy
• Push Enteroscopy
• Deep Enteroscopy
• Single/double ballon.
• spiral endoscopy.

16. radiologic imaging
• Mesentric Angiography
• Radionuclide scanning
• CT enterography and CT angiography

18. treatment
• Medical
• Endoscopic
• Balloon tamponade
• surgery
Priority:
Control the Haemorrhage

19. variceal bleeding
Esophageal
• Endoscopic- EVL, EST
• Balloon Tamponade-
Sengstaken Blakemore
tube
• Surgical- TIPS, Liver
transplant

20. variceal bleeding
Gastric
• Endoscopic
• Balloon Tamponade- Linton Nachalas tube
• Surgery- TIPS, Liver transplant

22. non variceal bleeding
Peptic Ulcer Disease (PUD)
• Medical.
• Endoscopic
• Angiographic Embolisation.
• Surgery.

23. modalities for endoscopic therapy
Injection Therapy
• Epinephrine
• Hypertonic saline
• Sclerosant- Absolute alcohol, polidoconol
• Tissue adhesive- cyanoacyralate
Thermal Therapy
• Contact- HP, Bipolar
• Non Contact- APC, Nd:YAG laser
Mechanical Therapy
• Endoclips
• Endoscopic band lgation
Combination Thepary

26. Thank you