Upper Gastrointestinal Bleeding - Diagnosis and Management

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Upper gastrointestinal bleeding is a fatal condition, if not tackle in time. Causes, diagnosis and management are being discussed in the presentation.

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Upper Gastrointestinal Bleeding - Diagnosis and Management

  1. 1. Dr Praveen Kumar
  2. 2. Definition  Bleeding proximal to the ligament of trietze
  3. 3. Anatomy
  4. 4. Presentation  Haematemesis  Malena  Haematochezia  Anemia  Fecal Occult Blood
  5. 5. Natural History  75% of cases will stop spontaneously  25% Will  Require surgery  Develop complications  Die Amount and Rate of Bleeding
  6. 6. Common Causes  Peptic ulcer  Duodenal ulcer  Gastric ulcer  Gastritis  Oesophagitis  Mallory – Weiss syndrome  Esophageal varices
  7. 7. Uncommon Causes  Gastric carcinoma  Pancreatitis  Haemobilia  Duodenal diverticulum
  8. 8. Immediate Management  Airway + Oxygen  Breathing  Circulation  Ng Tube?  Catheter?
  9. 9. Lab Investigations  FBC U&E  Clotting  Cross match
  10. 10. History  Mode of bleeding  Rate  Duration  Frequency  Co-morbidities  Bleeding tendencies  Drugs,warfarin,NSAID,
  11. 11. Examination  Physical exam  Clinical diagnosis of the cause is possible in 60% of cases
  12. 12. Assessment of the blood loss Estimated fluid and blood losses for 70 kg man CLASS 1 CLASS 2 CLASS 3 CLASS 4 Blood loss 750 -15% 750-1500 25-30% 1500-2000 30-40% >2000 >40% Pulse rate <100 >100 >120 >140 BP N N D D Pulse pressure N D D D RR 14-20 20-30 30-40 >35 UOP >30 20-30 5-15 Negligible CNS/MENTAL Slightly Anxious Mildly Anx Anx/conf Conf/leth Fluid replacement Crystalloid Crystalloid Cryst/blood Cryst/blood
  13. 13. Investigations  Endoscopy: OGD, Colonoscopy,enteroscopy  Construct study  CT – Scan  Angiography
  14. 14. Gastroscopy  Endoscopy should be done within 24 H  Adrenaline injection  Heat probe  Argon plasma coagulation
  15. 15. Surgery For uncontrollable bleeding by endoscopy (Severe upper GIT bleeding)
  16. 16. Risk Factors  Shock on presentation  Hb < 8 gm  Age > 60 Y  Gastric ulcer  Rebleeding  Spurting vessel  Deficiency of blood
  17. 17. Endoscopic erosive gastritis
  18. 18. Gastritis produced by aspirin and other nonsteroidal antiinflammatory drugs
  19. 19. Benign gastric ulcer
  20. 20. Duodenal ulcer
  21. 21. Cardia carcinoma
  22. 22. Mallory-Weiss tear
  23. 23. Two ulcers in the mid oesophagus
  24. 24. Large esophageal varices
  25. 25. Thanks

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