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Gastrointestinal bleeding
- 1. PRE TEST QUESTIONS • In acute upper GI bleed a rise in heart rate of >15 bpm indicates severe bleeding • Most common cause of upper gi bleeding is drug induced • Endoscopy should not be done before hemodynamic stabilisation in upper GI bleed
- 2. • Pharmacological therapy is main stay in variceal bleeding • It is not important to ascertain cause for GI bleed before planning treatment • Most patients with Mallory Weiss tear require ICU care and endoscopy
- 4. ACUTE UPPER GI BLEEDING DR SOURAB HIREMATH MD INTERNAL MEDICINE Emergency Medicine
- 5. CAUSES OF UPPER GI BLEEDING • Peptic Ulcer (35-60%) • Varices (4-31%) • Mallory Weiss tear (4-13%) • Gastroduoenal erosions (3-11%) • Erosive esophagitis • Malignancy • No source identified
- 6. HISTORY Alcohol consumption Previous viral hepatitis , jaundice Blood transfusion Malaena Past h/o Varices Bleeding due to CLD
- 7. OTHER HISTORY POINTS Pain abdomen Drugs eg. NSAIDS, warfarin , heparin aspirin , clopidogrel Disorders of coagulation
- 8. CLINICAL EXAMINATION Rule of thumb Drop in SBP >10 mmhg or rise in PR >15 BPM 10-20% loss of circulatory volume
- 9. SEVERITY OF BLEEDING Hypotension . SBP <100 mm of hg Tachycardi a PR >100 bpm Decreased urine output <0.5ml /kg/hr Agitation , restlessnes s drowsines s Cold peripherie s
- 10. RISK SCORING Blatchford scoring Other scorings Rockall score AIMS 65 score Baylor
- 11. MANAGEMENT ABC
- 12. RESUSCITATION ESTABLISH 2 LARGE BORE IV LINE OR CENTRAL LINE OBTAIN BLOOD FOR BLOOD TYPING , CBC, INR, APTT INFUSE NS, RL OR 5 % HETASTARCH BLOOD TRANSFUSIOn OXYGEN BY NASAL CANULA FACTORS PROPAGATING BLEEDING STOP OFFENDING DRUGS TREAT UNDERLYING COAGULATION ABNORMALITY LEVEL OF BLEEDING/ ETIOLOGY UPPER OR LOWER GI HISTORY AND EXAMINATION FOR ETIOLOGY
- 13. AFTER INITIAL ABC AND RESUSCITATION VARICEAL BLEEDING NON VARICEAL BLEEDING
- 14. VARICEAL BLEEDING TAMPONADE (SENGSTAKEN BLAKEMORE TUBE ) IF ENDOSCOPY THERAPY DELAYED OR NOT AVAILABLE
- 17. VARICEAL BLEEDING TAMPONADE (SENGSTAKEN BLAKEMORE TUBE ) IF ENDOSCOPY THERAPY DELAYED OR NOT AVAILABLE PHARMACOLOGICAL THERAPY
- 19. VARICEAL BLEEDING TAMPONADE (SENGSTAKEN BLAKEMORE TUBE ) IF ENDOSCOPY THERAPY DELAYED OR NOT AVAILABLE PHARMACOLOGICAL THERAPY ENDOSCOPIC THERAPY
- 20. Variceal banding
- 22. VARICEAL BLEEDING TAMPONADE (SENGSTAKEN BLAKEMORE TUBE ) IF ENDOSCOPY THERAPY DELAYED OR NOT AVAILABLE PHARMACOLOGICAL THERAPY ENDOSCOPIC THERAPY TIPS
- 24. VARICEAL BLEEDING TAMPONADE (SENGSTAKEN BLAKEMORE TUBE ) IF ENDOSCOPY THERAPY DELAYED OR NOT AVAILABLE PHARMACOLOGICAL THERAPY ENDOSCOPIC THERAPY TIPS SURGERY SPLEENECTOMY OR SHUNTS
- 25. AFTER INITIAL ABC AND RESUSCITATION VARICEAL BLEEDING NON VARICEAL BLEEDING
- 26. NON VARICEAL BLEEDING Initial resuscitation Pharmacologic therapy
- 28. NON VARICEAL BLEEDING Initial resuscitation Pharmacologic therapy Endoscopic therapy
- 30. NON VARICEAL BLEEDING Initial resuscitation Pharmacologic therapy Endoscopic therapy Angiography / surgery
- 31. MALLORY WEISS TEAR • Spontaneous bleeding stops in 85-90 % • If active bleeding persists : endoscopic therapy • Discharge after 1-2 days
- 32. THANK YOU