Author: Ms Christa Maria Joel Supervisor: Dr Roy (Gastroenterologist) Department of General Surgery Father Muller Medical College 4th Year MBBS

1. Treatment in
Upper
Gastrointestinal
Bleeding
CHRISTA MARIA JOEL

2.  General
 Medical therapy
 Endoscopic therapy
 CT angiography guided embolization
 Surgical treatment

3. General therapy
 IV fluids
 Catheterisation
 Ryle’s tube aspiration: to reduce
vomiting and to prevent aspiration
of stomach contents into lungs.
 Blood transfusion

4. Medical therapy
 Injection ranitidine IV 50mg 8th
hourly or famotidine IV,
omeprazole IV and pantoprazole
IV.
 Antifibrinolytics like tranexamic
acid and EACA.
 Somatostatin or octreotide, PPI
infusion.

5. Endoscopic therapy
 First line of therapy in all upper GI
bleed.
 Laser coagulation- can arrest bleeding
without direct tissue contact.
 Sclerotherapy- epinephrine (1:10000)
and 2% ethanolamine.
 Haemoclip application

6. CT angiography guided
embolisation
 Embolisation of gastroduodenal
artery is very useful in bleeding
ulcers if endoscopic therapy fails.

7. Surgical management
 For peptic ulcer:
- Finney’s pyloroplasty:
gastroduodenostomy between anterior
surface of stomach and duodenum
Single inverted
u or v shaped
incision is
made through
prepyloric
antrum,
pylorus and 1st
part of
duodenum
Posterior inner
layer of
gastroduodenal
anastomosis is
completed with
a continuous
full thickness
suture.
Anterior inner
layer is
completed with
a continuous
inverting
suture.

8. - Partial gastrectomy
- Ligation of gastroduodenal or left gastric
artery.

9.  For varices:
- Boerema-Crile operation:
Patient in
right in lateral
position.
Thoractomy is
done through
8th rib.
Esophagus
dissected and
isolated,
clamp applied
at cardia,
esophagus
opened
longitudinally
to hold edges
with sutures.
Varices
columns
under run
using
continuous
sutures.
Esophageal
incised muscle
layer
resutured
again.

10. - Hasaab operation: devascularisation and
splenectomy.
- Oesophageal transection: removal of lower
5cm esophagus with end to end
anastomosis.
- Siguira – Futagawa operation: vagotomy,
pyloroplasty, devascularisation and
splenectomy.
- TIPSS: artificial communication between
inflow portal vein and outflow hepatic vein.