Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Upper gi tract bleed

1,356 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Upper gi tract bleed

  1. 1. Upper GI tract bleed
  2. 2.  Upper GI bleed presents with hematemesis  Hematemesis means vomiting of blood  The appearance of hematemesis resembles coffee grounds  It indicates bleeding from upper GI usually from esophagus, stomach and duodenum above ligament of treitz  Conditions which cause hematemesis can also cause melena
  3. 3. Causes of Upper GI bleed  Peptic ulcer  Esophageal varices  Erosive gastritis  Esophagitis  Mallory weiss syndrome  Carcinoma stomach  Hereditary hemorrhagic telengeictasia  Bleeding disorders
  4. 4. Peptic ulcer  It means ulcers in those parts of the gut which are exposed to acid.  Common sites are duodenum , stomach and can also occur in lower esophagus.  Causes:  Increase acid secretion(duodenal ulcer)  Decrease mucosal resistance(gastric ulcer)  NSAIDs ingestion  H.Pylori infection  Zollinger Ellison syndrome (uncommon)
  5. 5.  Peptic ulcer pain is felt in the epigastrium and is well localized. Patient points with one finger to the site of pain- the ‘pointing sign’-  Duodenal ulcer  Occurs in the 1st part of duodenum.  Symptoms include  Pain epigastrium aggravated by empty stomach(hunger pain), relieved by food and antacids  Nocturnal pains occur  Pain in the morning is not due to peptic ulcer  History of periodicity may be present.  Signs  Localized tenderness in the epigastrium
  6. 6. Investigation  Barium meal shows duodenal deformity/ulcer crater.  Endoscopy confirms ulcer presence.
  7. 7. Gastric ulcer  Symptoms  Relation of pain to meals and timings is variable  May be relieved or aggravated by food  Nocturnal pain is uncommon  Signs  Epigastric tenderness  Investigation  Barium meal shows ulcer crater  Endoscopy confirms  Every gastric ulcer must be biopsied to exclude malignancy
  8. 8. Treatment  1st line therapy includes  PPI ,Antibiotics( clarithromycin and amoxicillin)  2nd line therapy includes quadruple therapy  PPI ,Antibiotics(clarithromycin and amoxicillin) bismuth  For long term ulcer use only PPI  Complications of peptic ulcer  Bleeding  Perforation  Chronicity  Gastric outlet obstruction
  9. 9. Esophageal varices  These are dilated tortuous veins in the esophagus  These are communication channels between the portal and systemic venous systems and become dilated in portal hypertension  Most common cause of portal hypertension is hepatic cirrhosis
  10. 10.  Symptoms  Hematemesis is massive and recurrent  Distention of abdomen due to ascites  History of jaundice  Hematemesis may be the first manifestation of cirrhosis  Signs  Jaundice  Dependent edema  Gynecomastia and testicular atrophy  Palmar erythema, dupuytren’ contracture, Spider angiomas, parotid swelling (common in alcoholic cirrhosis)
  11. 11.  Veins of abdominal wall may be prominent  Liver may be enlarged/shrunken  Palpable spleen  Ascites in advanced disease Investigation  Endoscopy
  12. 12. treatment  I.V fluid replacement with 0.9% saline  Vasopressor  Prophylactic antibiotics (cephalosporin)  Variceal band ligation  PPI  Lactulose
  13. 13. Erosive gastritis  In addition to inflammation of stomach, there are multiple mucosal erosions and petechiae.  Causes  A. drugs  Aspirin and NSAIDS  Theophylline  Potassium chloride  B. stress  Head injury  Shock  Trauma  Burns  Sepsis  Hepatic encephalopathy
  14. 14. Symptoms  Hematemesis with or without epigastric pain  h/o drug intake Signs  Tenderness in the epigastrium Investigation  Endoscopy
  15. 15. Esophagitis  Abnormal reflux of gastric contents into lower esophagus is the most common cause of esophagitis  Smokers and obese are more prone Symptoms  Retrosternal burning and pain(heart burn), increases on bending forward or lying flat  Relieved by antacids
  16. 16.  History of regurgitation  Water brash  Bitter taste in the morning  Persistent dysphagia indicates peptic stricture  Aspiration of regurgitant material cause laryngitis and aspiration pneumonia  Signs  Pallor may occur  Investigation  Barium swallow demonstrates reflux  Esophageal ulcers may be seen
  17. 17.  Endoscopy shows  Hyperemic mucosa with or without ulcers  If mucosa looks normal , biopsy will demonstrate microscopic inflammation  PH monitoring <4 for >4% of time is suggestive of acid reflux  Treatment  Lifestyle modification  PPI  H2 antagonists  Prokinetic drugs
  18. 18. Mallory weiss syndrome  Repeated retching and vomiting can cause vertical mucosal tear at gastroesophageal junction Symptoms  H/o repeated vomiting and retching before hematemesis
  19. 19. Sign  Epigastric tenderness Investigation  Endoscopy
  20. 20. Carcinoma stomach  Occurs after age of 40 years  Risks include  Pernicious anemia  Partial gastrectomy  Gastroenterostomy  Symptoms  Loss of appetite, nausea and discomfort after meal  Vague epigastric pain and feeling of distention after meals  Early satiety is common  Persistent vomiting if gastric outlet obstruction  Marked loss of weight
  21. 21.  Signs  Pallor  Epigastric mass may be palpable  In later stages, patient may have enlarged scalene lymph nodes, nodular liver and ascites due to metastases  Investigation  Iron deficiency anemia  Barium meal shows filling defect  Endoscopy shows mass/ulcer  Biopsy confirms diagnosis. In case of ulcer, six biopsies should be taken  Treatment  Gastrectomy (partial and complete)  Palliative treatment
  22. 22. Hereditary hemorrhagic telengeiectasis  It is an autosomal dominant disease.  Bleeding occurs from multiple telangiectasias which consists of localized collection of non-contractile capillaries. Symptoms  Recurrent hematemesis/epistaxsis/hemoptysis
  23. 23.  Sites of telangiectasias  Face  Hands  Mucous membranes of nose, oral cavity and GIT Investigation  Telengiectasia may be seen in gastric mucosa on Gastroscopy
  24. 24. Bleeeding disorders  Causes  A. Defects of blood vessels:  Vascular purpura  Hereditary hemorrhagic telengiectasia  B. Platelet disorders  Thrombocytopenia  Thrombocythemia  Thromboasthenia
  25. 25.  C. Clotting disorders  Hereditary  Hemophilia  Christmas disease  Von willebrand disease  Acquired  Vitamin K deficiency  Oral anticoagulant therapy  Advanced liver disease  D. Consumption coagulopathy  DIC
  26. 26. Basic investigations  Full blood count show anemia  Urea and electrolytes :elevated urea with normal creatinine concentration implies severe bleeding  Liver function tests may show evidence of chronic liver disease  Prothrombin time shows bleeding disorders and liver synthetic dysfunctions
  27. 27. Management of upper GI bleeding  Intravenous access using one large bore cannula  Initial clinical assessment  Define circulatory status  Seek evidence of liver disease  Identify other comorbidity  Resuscitation with crystalloids or transfusion in severe bleeding  Ventilation with oxygen mask  Monitoring of B.P and urinary output  Endoscopy should be performed within 24 hours. It is used in treatment of bleeding from peptic ulcer using injection of epinephrine and thermal clips.in varicial bleeding band ligation is also done endoscopically.  Surgery
  28. 28. History taking related to GI bleeding  Duration  Episodes of hematemesis  Quantity  Color(coffee ground appearance)  Blood in stools (maroon colored stools can be present in acute severe upper GI bleeding)  History of jaundice(cirrhosis)  History of epigastric pain (peptic ulcer, esophagitis, erosive gastritis)  Weight loss (carcinoma stomach)
  29. 29. Signs in upper GI bleeding  Anemia  Epigastric tenderness  Ascites  Hepatomegaly and spleenomegaly  Jaundice  Palmar erythema ,dupuytren contracture, Spider angiomas ,parotid swelling in alcoholic cirrhosis  Gynecomastia and testicular atrophy  Prominent abdominal veins  Dependent edema  Abdominal mass  Palpable scalene, paraumblical , virchow’ lymph nodes
  30. 30. Thanks

×