Gi bleeding

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Gi bleeding

  1. 1. Gastrointestinal Bleeding By Group F2 subgroup C
  2. 2. Contents • • • • • • Initial Evaluation ( History & Examination ) Approach to the Patient Sources Upper GI Bleeds Lower GI Bleeds Management
  3. 3. Evaluation (History) • • • • • • Hematemesis (coffee grounds vs. bright red) Hematochezia = Bleeding per rectum Melena Pain symptoms Medications eg. NSAIDs, steroids, Iron…etc PMHx eg. Peptic ulcer , Alcoholism
  4. 4. Evaluation (Examination) • • • • • • General examination Abdominal examination Rectal examination Stigma of Cirrhosis NG Tube findings (upper vs. lower GI source) Urine output
  5. 5. Approach to the patient • CBC • Serial Hgb • Platelets • Basic metabolic panel (BMP) • Blood urea nitrogen (BUN) • Creatinine (Cr) • Blood type and crossmatch • Coagulation studies • Imaging studies
  6. 6. Sources of GIT Bleeding Upper GIT • Esophagus Varices, Esophagitis • Stomach ulcer, cancer, Gastritis, varices • Duodenum ulcer, fistula, AVM (Arteriovenous malformation)
  7. 7. Sources of GIT Bleeding Lower GIT • Small Bowel AVM, Crohn’s disease, Cancer, Meckel’s diverticulum, Vasculitis • Colon Diverticulosis, AVM, Ischemic gut, Infectious, IBD, Cancer • Anal Hemorrhoid, Fissure • Systemic Coagulopathy
  8. 8. Management • • • • Airway Protection and Oxygen IV Access central or peripheral (2 sites) Isotonic saline for volume resuscitation Blood transfusion indications • transfusing should be based on hemodynamic status, not lab value of Hgb. • cardiac ischemia, dyspnea, low pulse pressure • ICU admission if Significant bleeding with hemodynamic instability
  9. 9. Thank You!

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