Downloaded 44 times
Uploaded byShybin Usman
Gastrointestinal bleed overview
This document discusses gastrointestinal (GI) bleeding, including its definitions, symptoms, causes, management, and prevention. GI bleeding can occur in the upper or lower GI tract, and may present as vomiting blood, black stools, or blood in the rectum. Common causes include peptic ulcers, esophageal varices, colon polyps, and diverticulosis. Management involves stabilizing the patient, stopping the bleeding, identifying the source of bleeding, and preventing recurrence. Endoscopy allows for diagnosis and potential treatment through procedures like ligation or sclerosing of varices. Surgery may be considered for severe or recurrent bleeding. Scoring systems can help determine prognosis and appropriate care settings.
More Related Content
Similar to Gastrointestinal bleed overview
Gastrointestinal bleed overview
- 1.
- 2. DEFINITIONS Haemetemesis –Vomiting fresh/altered blood Melena – Altered blood in faeces Hematochezia – Fresh blood/clots per rectum Faecal occult blood – Not visible, detected by lab tests for RBC degradation products Obscure Bleeding – GI blood loss, unknown origin, recurs/persists after intial neg endoscopic eval.
- 3. SYMPTOMS Acute bleed– upper/lower Fatigue, weakness, abd pain, pallor Hypotension, hypovolemic shock
- 4. CAUSES UPPER GI Peptic ulcer Gastric or esophageal varix Esophagitis Upper gastrointestinal tract tumor Angioma Mallory-Weiss tear Erosions Dieulafoy’s lesion Other
- 5. CAUSES LOWER GI Diverticulosis Colon cancer or polyps Colitis (Noninfectious & Infectious) Ischemic colitis IBD Angioectasia Postpolypectomy Rectal ulcer Hemorrhoids Anorectal source Radiation colitis Other Unknown
- 6. SCORING SYSTEM Rockallscoring for upper GI (0-11) Parameters:- Age Pulse rate Systolic BP Comorbidity Endoscopic Dx Endoscopic stigmata of recent bleed <3=Good, >8=Very bad
- 7. SCORING ALTERNATE Glasgow– Blatchford:- Whom to Rx as OP
- 8. MANAGEMENT Stabilize thepatient Stop the bleeding Find the source of bleeding Prevent recurrence of bleeding
- 9. IMMEDIATE Assess clinicalstatus PR, BP, RR, Conciousness Large bore IV access – 2 Stabilize haemodynamics IV fluids, PRBC, Whole blood Vasopressors NG aspirate – Large bleeds, doubtful bleeds
- 10. LAB TESTS Completeblood counts Hb, TC, DC, ESR Coag profile PT, INR, APTT, Platelet count Blood group, cross-match LFT RFT
- 11. SPECIAL INVESTIGATIONS TaggedRBC scintigraphy Arteriography
- 12. HISTORY & EXAMINATION Drugs – OAC, NSAID, Aspirin, Doxycycline Alcohol, Chronic Liver Disease Coagulation disorders Retching Carcinoma, Polyps Radiation, Surgery (abd, aortic) H/o embolism
- 13. EXTRAS Stop anticoagulants FFP Vit K Protamine (for heparin) Platelet conc – for low platelet count Enema, prokinetics ETT – Unconscious, severe bleed
- 14. SPECIALS Non-variceal –PPI Variceal - Octreotide (synthetic Somatostatin) Vasopressin CLD - Cephalosporins
- 15. INTERVENTIONS Endoscopy :- Diagnostic Therapeutic – Ligation, Banding, Clipping, Sclero Sengstaken-Blakemore tube :- Variceal bleed Embolisation of bleeding artery
- 16. SURGICAL OPTION Indication:- Haemodynamic instability Clinical deterioration >6 units of transfusion Persistent/Recurrent bleed
- 17. SURGERY - HOW Excision Under-running sutures Ligation of artery TIPSS Splenectomy
- 18. OBSCURE TYPE Headachefor gastroenterologist Capsule endoscopy Exploratory laparotomy
- 19. PROPHYLAXIS Peptic ulcer– PPI H.Pylori eradication Variceal – Β blockers TIPSS Splenectomy
- 20. And that isit for now