Upper GI bleeding accounts for nearly 80% of significant gastrointestinal bleeding. Common causes of upper GI bleeding include peptic ulcer disease, esophageal varices, Mallory-Weiss syndrome, and erosive gastropathy. Lower GI bleeding accounts for about 20% and possible causes include diverticular disease, vascular abnormalities like angiodysplasia, inflammatory conditions, and neoplasms. Evaluation of a patient with GI bleeding involves assessing severity, identifying potential sources, and looking for conditions that may impact management. Initial evaluation includes history, physical exam, and lab tests. Endoscopy allows for diagnosis and potential treatment.
This document provides an overview of lower gastrointestinal bleeding (LGIB), including its definition, etiology, clinical features, diagnostic and therapeutic approaches. It discusses how LGIB accounts for 20% of gastrointestinal bleeding cases and can be safely managed in an outpatient setting once initial resuscitation and risk evaluation is complete. Colonoscopy is highlighted as the first-line investigation, while angiography and surgery are reserved for more severe or refractory cases. The overall mortality rate of LGIB is reported to be less than 5%.
This document discusses the management of gastrointestinal bleeding. It begins with an overview of the upper and lower GI tract as sources of bleeding. It then covers initial patient assessment, history taking, differential diagnosis, investigations and conservative versus therapeutic management approaches. Specific topics discussed in more detail include fluid resuscitation, endoscopic diagnostic and therapeutic options, predictors of rebleeding and need for surgery, as well as approaches to managing various underlying causes of GI bleeding.
A 45-year-old male presented with hematemesis after vomiting blood the previous night. When confronted with a patient with hematemesis, the doctor should determine if it is truly hematemesis, assess the stability and estimated blood loss of the patient, consider possible lesions and their locations and blood supplies. A thorough history and examination is needed to correctly diagnose the source of bleeding. Initial management includes resuscitation with fluids and blood products as needed, passing a nasogastric tube, and arranging for urgent endoscopy within 18 hours. Long-term management depends on the findings and may include treatments like antibiotics, pharmacotherapy, endoscopic therapy, TIPS, or surgery.
This document summarizes the management of upper gastrointestinal bleed. It begins with two clinical scenarios of patients presenting with GI bleed and then covers the epidemiology, causes, signs and symptoms, risk scores for prognosis, and approaches to treatment. It emphasizes the importance of early endoscopy and acid suppression treatment. Medications discussed include PPIs, somatostatin analogs like octreotide, terlipressin, antibiotics and tranexamic acid which is being studied in the HALT-IT trial to reduce mortality from GI bleed. Discharge instructions include avoiding NSAIDs and treating H. pylori infection.
This document provides an overview of approaches to gastrointestinal bleeding. It discusses the common clinical presentations including hematemesis, melena, hematochezia, and occult bleeding. For hematemesis, the most common causes are discussed such as stress ulcers, Mallory-Weiss tears, peptic ulcer disease, gastroesophageal varices, and Dieulafoy's lesion. For hematochezia, common causes include colonic diverticula, internal hemorrhoids, colon cancer, and inflammatory bowel disease. The document provides details on evaluating each potential cause and characteristics to consider in the clinical history and examination.
Upper GI bleeding refers to bleeding from the GI tract proximal to the ligament of Trietz. Non-variceal bleeding accounts for 80% of cases, with peptic ulcer disease being the most common cause at 30-40%. Portal hypertensive bleeding from gastroesophageal varices accounts for the remaining 20% of cases. Early endoscopy within 24 hours of bleeding results in reduced transfusions, decreased need for surgery, and shorter hospital stays. Endoscopic therapies like epinephrine injection and thermal coagulation are effective first-line treatments for actively bleeding ulcers. Surgery is indicated if bleeding cannot be controlled or for recurrent bleeding. Variceal bleeding requires resuscitation, vasoactive drugs, and endoscopic
Upper gastrointestinal bleeding is a common medical condition that requires prompt assessment and treatment. Key steps in evaluation include determining hemodynamic stability, performing nasogastric aspiration to identify the source and activity of bleeding, and endoscopy within 24 hours of presentation to identify the cause and risk stratify patients. Resuscitation focuses on restoring circulating volume through blood transfusions and intravenous fluids while controlling active bleeding endoscopically. Risk stratification scores like Rockall and Blatchford are used to determine patient disposition and guide management.
UGIB can be defined as bleeding from the gastrointestinal tract above the ligament of Treitz. The most common causes are peptic ulcers, varices, and Mallory-Weiss tears. Presentation includes hematemesis, melena, hematochezia, or signs of blood loss. Management involves resuscitation, endoscopic diagnosis and treatment such as band ligation or coagulation, and drug therapy like PPIs or vasoconstrictors. Prognosis depends on age, comorbidities, signs of shock, and rebleeding risk.
This document provides an overview of lower gastrointestinal bleeding (LGIB), including its definition, etiology, clinical features, diagnostic and therapeutic approaches. It discusses how LGIB accounts for 20% of gastrointestinal bleeding cases and can be safely managed in an outpatient setting once initial resuscitation and risk evaluation is complete. Colonoscopy is highlighted as the first-line investigation, while angiography and surgery are reserved for more severe or refractory cases. The overall mortality rate of LGIB is reported to be less than 5%.
This document discusses the management of gastrointestinal bleeding. It begins with an overview of the upper and lower GI tract as sources of bleeding. It then covers initial patient assessment, history taking, differential diagnosis, investigations and conservative versus therapeutic management approaches. Specific topics discussed in more detail include fluid resuscitation, endoscopic diagnostic and therapeutic options, predictors of rebleeding and need for surgery, as well as approaches to managing various underlying causes of GI bleeding.
A 45-year-old male presented with hematemesis after vomiting blood the previous night. When confronted with a patient with hematemesis, the doctor should determine if it is truly hematemesis, assess the stability and estimated blood loss of the patient, consider possible lesions and their locations and blood supplies. A thorough history and examination is needed to correctly diagnose the source of bleeding. Initial management includes resuscitation with fluids and blood products as needed, passing a nasogastric tube, and arranging for urgent endoscopy within 18 hours. Long-term management depends on the findings and may include treatments like antibiotics, pharmacotherapy, endoscopic therapy, TIPS, or surgery.
This document summarizes the management of upper gastrointestinal bleed. It begins with two clinical scenarios of patients presenting with GI bleed and then covers the epidemiology, causes, signs and symptoms, risk scores for prognosis, and approaches to treatment. It emphasizes the importance of early endoscopy and acid suppression treatment. Medications discussed include PPIs, somatostatin analogs like octreotide, terlipressin, antibiotics and tranexamic acid which is being studied in the HALT-IT trial to reduce mortality from GI bleed. Discharge instructions include avoiding NSAIDs and treating H. pylori infection.
This document provides an overview of approaches to gastrointestinal bleeding. It discusses the common clinical presentations including hematemesis, melena, hematochezia, and occult bleeding. For hematemesis, the most common causes are discussed such as stress ulcers, Mallory-Weiss tears, peptic ulcer disease, gastroesophageal varices, and Dieulafoy's lesion. For hematochezia, common causes include colonic diverticula, internal hemorrhoids, colon cancer, and inflammatory bowel disease. The document provides details on evaluating each potential cause and characteristics to consider in the clinical history and examination.
Upper GI bleeding refers to bleeding from the GI tract proximal to the ligament of Trietz. Non-variceal bleeding accounts for 80% of cases, with peptic ulcer disease being the most common cause at 30-40%. Portal hypertensive bleeding from gastroesophageal varices accounts for the remaining 20% of cases. Early endoscopy within 24 hours of bleeding results in reduced transfusions, decreased need for surgery, and shorter hospital stays. Endoscopic therapies like epinephrine injection and thermal coagulation are effective first-line treatments for actively bleeding ulcers. Surgery is indicated if bleeding cannot be controlled or for recurrent bleeding. Variceal bleeding requires resuscitation, vasoactive drugs, and endoscopic
Upper gastrointestinal bleeding is a common medical condition that requires prompt assessment and treatment. Key steps in evaluation include determining hemodynamic stability, performing nasogastric aspiration to identify the source and activity of bleeding, and endoscopy within 24 hours of presentation to identify the cause and risk stratify patients. Resuscitation focuses on restoring circulating volume through blood transfusions and intravenous fluids while controlling active bleeding endoscopically. Risk stratification scores like Rockall and Blatchford are used to determine patient disposition and guide management.
UGIB can be defined as bleeding from the gastrointestinal tract above the ligament of Treitz. The most common causes are peptic ulcers, varices, and Mallory-Weiss tears. Presentation includes hematemesis, melena, hematochezia, or signs of blood loss. Management involves resuscitation, endoscopic diagnosis and treatment such as band ligation or coagulation, and drug therapy like PPIs or vasoconstrictors. Prognosis depends on age, comorbidities, signs of shock, and rebleeding risk.
This document discusses upper gastrointestinal bleeding, presenting the case of a patient complaining of vomiting blood. It defines upper GI bleeding as bleeding proximal to the ligament of Treitz. The document outlines the common causes of upper GI bleeding, presenting differential diagnoses in a "PAGE ME" mnemonic. It then discusses the approach to evaluating and managing a patient with upper GI bleeding, including history, physical exam, investigations to identify the source of bleeding, and treatments depending on the identified cause. Finally, it presents several case scenarios and discusses the likely diagnoses and management approaches.
This document provides an overview of lower gastrointestinal bleeding, including definitions, epidemiology, causes, diagnosis, and management. Some key points:
- Lower GI bleed most commonly originates from the colon, with diverticular disease and angiodysplasias being the most frequent underlying causes.
- Diagnosis involves digital rectal exam, endoscopic procedures like sigmoidoscopy and colonoscopy, and imaging tests like radionuclide scanning.
- Specific colonic conditions that may cause bleeding include diverticular disease, angiodysplasias, colitis, infections, radiation proctitis, and anorectal diseases.
- Small bowel sources of bleeding include angiodysplasias,
A 44-year-old female presented with loose stools and blood in her stool for one month. She has a history of inflammatory bowel disease. Chronic diarrhea can be caused by secretory, osmotic, steatorrheal, inflammatory, or dysmotility issues. An evaluation of the patient's history, exam, and labs can help determine the underlying cause, such as celiac disease, inflammatory bowel disease, or medication side effects. Treatment involves rehydration, managing the underlying cause, and symptomatic relief with medications as needed.
This document discusses lower gastrointestinal (GI) bleeding, including its causes, presentation, evaluation, and management. Some key points:
- The most common causes of major LGI bleed are diverticulosis, colonic neoplasms, and angiodysplasias. Colonoscopy is the investigation of choice.
- Occult LGI bleeding is first evaluated with fecal occult blood testing (FOBT). CT angiography can help localize bleeding if it persists or patients are unstable.
- Evaluation involves history, physical exam including rectal exam, blood tests, stool tests, endoscopy, imaging studies like colonoscopy, angiography or nuclear scans depending on findings.
- Treatment depends on
Lower gastrointestinal bleeding can have various causes like diverticulosis, angiodysplasia, inflammation, and cancers. A thorough history, physical exam, and initial tests like colonoscopy are important to determine the source and severity of bleeding. Colonoscopy allows for both diagnosis and potential treatment but often requires bowel prep, while angiography and CT angiography can localize active bleeding but lack therapeutic options. Together, these diagnostic tests aim to safely identify the cause and guide appropriate clinical management of lower GI bleeding.
Approach to patients with upper gi bleedingRajesh S
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
Upper Gastrointestinal Bleeding (UGIB) - General ApproachMohamed Badheeb
What does the science & evidence say about UGIB ?
Introduction & Background on Upper GI Bleeding.
- Incidence and Epidemiology
- Etiologies
2. Guidelines on UGIB
- Resuscitation, Risk assessment
- Diagnostic Modalities
- Treatment Options
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
This document provides an overview of the approach to upper GI bleeding. It begins with definitions of terms like hematemesis, melena, and hematochezia. It then discusses the causes of upper GI bleeding, which can be variceal or non-variceal. For patients presenting with upper GI bleeding, the summary provides that history, physical exam, and investigations like endoscopy are important to determine the cause and guide management. Management may involve treating any active bleeding, administering PPIs for non-variceal bleeding, or using vasoactive agents, balloon tamponade, or endoscopic therapies for variceal bleeding.
This document discusses lower gastrointestinal bleeding (LGIB), which occurs in the small and large intestines, presenting as hematochezia or melaena. Common causes of LGIB include diverticular disease, inflammatory bowel diseases like Crohn's disease and ulcerative colitis, ischemic colitis, vascular malformations, polyps, tumors, and anal issues. LGIB is typically chronic and self-limiting, though some cases are acute and require blood transfusion. The diagnostic workup depends on the patient's age and symptoms, and may involve endoscopy, imaging, or angiography to identify the source of bleeding.
This document discusses lower gastrointestinal (GI) bleeding, including:
- Causes such as angiodysplasia, carcinoma, diverticulosis, and anorectal diseases.
- Clinical evaluation involving history of presenting symptoms, physical exam, investigations to localize the source of bleeding such as colonoscopy, and management including resuscitation, treating the underlying cause, and potential surgical intervention for massive or recurrent bleeding.
- Diagnostic tools like colonoscopy, mesenteric angiography, and radionuclide scanning along with their advantages and disadvantages.
This document outlines a presentation on the pathophysiology and management of acute abdomen. It begins with definitions of acute abdomen and types of abdominal pain. Pathophysiological mechanisms including luminal obstruction, inflammation, peritonitis, ischemia and non-specific pain are described. Common causes like appendicitis, cholecystitis, bowel obstruction and perforated viscus are listed. Immediately life-threatening diagnoses of perforated viscus, bowel ischemia, ruptured abdominal aortic aneurysm and ruptured ectopic pregnancy are highlighted. Clinical assessment techniques and investigations are outlined. Management principles focusing on ABCs, fluid resuscitation and need for surgery in some cases are emphasized in the take-home message.
1. The document discusses gastrointestinal bleeding, describing its various presentations including hematemesis, melena, hematochezia, occult blood in stools, and chronic blood loss/anemia.
2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
This document discusses lower gastrointestinal bleeding, including its definition, causes, clinical presentation, risk stratification, localization techniques, and treatment approaches. The main causes of lower GI bleeding discussed are diverticular diseases, hemorrhoids, angiodysplasia, inflammatory bowel disease, and neoplasms. Initial management involves resuscitation, risk stratification, and localization of the bleeding site using techniques such as colonoscopy, radionuclide scanning, and mesenteric angiography. Treatment depends on the underlying cause but may include pharmacologic, endoscopic, angiographic, or surgical interventions.
Lower gastrointestinal bleeding (LGIB) is commonly caused by hemorrhoids but should be investigated. The most common causes of LGIB are diverticulosis, colonic arteriovenous malformations, and colitis. LGIB affects mostly the elderly, with a mean age of 63-77 years. Approximately 85% of LGIB originates in the colon. Diverticular disease is the leading specific cause, with bleeding often occurring from the sigmoid colon. Colonic arteriovenous malformations are also a major source of LGIB.
Upper gastrointestinal (UGI) bleeding can originate from the esophagus, stomach, or duodenum. The document discusses the causes, clinical presentations, associated conditions, and endoscopic findings of UGI bleeding. The major causes include peptic ulcers, esophageal or gastric varices, esophagitis, vascular ectasias, tumors, and Dieulafoy's lesions. An evaluation of UGI bleeding involves assessing severity based on history and labs, and identifying potential bleeding sources and comorbidities to guide management. Endoscopy allows visualization of the source and features to determine the risk of rebleeding.
Upper GI bleeding refers to bleeding that originates in the esophagus, stomach, or duodenum. Common causes include peptic ulcers, esophageal varices, and gastritis. Risk factors include NSAID/aspirin use and H. pylori infection. Diagnosis involves history, physical exam, endoscopy, and blood tests. Management depends on risk level and includes hemodynamic stabilization, endoscopy, and treatment of the underlying cause. Outcomes range from full recovery to mortality rates as high as 30% in severe or continuing bleeding cases.
This document discusses lower gastrointestinal bleeding, including its definition, causes, symptoms, diagnosis, and management. The most common causes of lower GI bleeding are diverticular disease and angiodysplasia. Diagnostic tests include colonoscopy, angiography, and radionuclide scanning. Colonoscopy allows for diagnosis and treatment but requires bowel prep, while angiography and scanning are less invasive but also less accurate. Management depends on the severity and cause of bleeding, and may include blood transfusions, endoscopic therapies, angiography, or surgery in severe cases.
This document discusses gastrointestinal (GI) bleeding, including:
1) GI bleeding can present as overt (visible bleeding) or occult (hidden bleeding) and can originate from the upper or lower GI tract. Common symptoms include hematemesis, melena, and hematochezia.
2) Etiologies of upper GI bleeding include esophageal varices, peptic ulcers, Mallory-Weiss tears, and Dieulafoy's lesions. Management involves endoscopy, vasoactive drugs, proton pump inhibitors, and blood transfusions.
3) Lower GI bleeding can originate from the small intestine or colon. Causes include vascular ectasias, cancers, diverticulosis, and inflammatory bowel disease
This document discusses gastrointestinal bleeding, including:
- Gastrointestinal bleeding can arise from any location in the GI tract and represents the initial symptom of GI disease in 1/3 of patients.
- Clinical presentations of GI bleeding include hematemesis, melena, hematochezia, occult bleeding, and symptoms of blood loss/anemia.
- Common causes of upper GI bleeding are peptic ulcers and esophageal varices, while diverticulosis and colon polyps are common causes of lower GI bleeding.
- The approach to a patient with GI bleeding involves stabilizing their hemodynamic status, identifying the source of bleeding, stopping active bleeding, treating the underlying cause, and preventing recurrent
This document discusses upper gastrointestinal bleeding, presenting the case of a patient complaining of vomiting blood. It defines upper GI bleeding as bleeding proximal to the ligament of Treitz. The document outlines the common causes of upper GI bleeding, presenting differential diagnoses in a "PAGE ME" mnemonic. It then discusses the approach to evaluating and managing a patient with upper GI bleeding, including history, physical exam, investigations to identify the source of bleeding, and treatments depending on the identified cause. Finally, it presents several case scenarios and discusses the likely diagnoses and management approaches.
This document provides an overview of lower gastrointestinal bleeding, including definitions, epidemiology, causes, diagnosis, and management. Some key points:
- Lower GI bleed most commonly originates from the colon, with diverticular disease and angiodysplasias being the most frequent underlying causes.
- Diagnosis involves digital rectal exam, endoscopic procedures like sigmoidoscopy and colonoscopy, and imaging tests like radionuclide scanning.
- Specific colonic conditions that may cause bleeding include diverticular disease, angiodysplasias, colitis, infections, radiation proctitis, and anorectal diseases.
- Small bowel sources of bleeding include angiodysplasias,
A 44-year-old female presented with loose stools and blood in her stool for one month. She has a history of inflammatory bowel disease. Chronic diarrhea can be caused by secretory, osmotic, steatorrheal, inflammatory, or dysmotility issues. An evaluation of the patient's history, exam, and labs can help determine the underlying cause, such as celiac disease, inflammatory bowel disease, or medication side effects. Treatment involves rehydration, managing the underlying cause, and symptomatic relief with medications as needed.
This document discusses lower gastrointestinal (GI) bleeding, including its causes, presentation, evaluation, and management. Some key points:
- The most common causes of major LGI bleed are diverticulosis, colonic neoplasms, and angiodysplasias. Colonoscopy is the investigation of choice.
- Occult LGI bleeding is first evaluated with fecal occult blood testing (FOBT). CT angiography can help localize bleeding if it persists or patients are unstable.
- Evaluation involves history, physical exam including rectal exam, blood tests, stool tests, endoscopy, imaging studies like colonoscopy, angiography or nuclear scans depending on findings.
- Treatment depends on
Lower gastrointestinal bleeding can have various causes like diverticulosis, angiodysplasia, inflammation, and cancers. A thorough history, physical exam, and initial tests like colonoscopy are important to determine the source and severity of bleeding. Colonoscopy allows for both diagnosis and potential treatment but often requires bowel prep, while angiography and CT angiography can localize active bleeding but lack therapeutic options. Together, these diagnostic tests aim to safely identify the cause and guide appropriate clinical management of lower GI bleeding.
Approach to patients with upper gi bleedingRajesh S
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
Upper Gastrointestinal Bleeding (UGIB) - General ApproachMohamed Badheeb
What does the science & evidence say about UGIB ?
Introduction & Background on Upper GI Bleeding.
- Incidence and Epidemiology
- Etiologies
2. Guidelines on UGIB
- Resuscitation, Risk assessment
- Diagnostic Modalities
- Treatment Options
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
This document provides an overview of the approach to upper GI bleeding. It begins with definitions of terms like hematemesis, melena, and hematochezia. It then discusses the causes of upper GI bleeding, which can be variceal or non-variceal. For patients presenting with upper GI bleeding, the summary provides that history, physical exam, and investigations like endoscopy are important to determine the cause and guide management. Management may involve treating any active bleeding, administering PPIs for non-variceal bleeding, or using vasoactive agents, balloon tamponade, or endoscopic therapies for variceal bleeding.
This document discusses lower gastrointestinal bleeding (LGIB), which occurs in the small and large intestines, presenting as hematochezia or melaena. Common causes of LGIB include diverticular disease, inflammatory bowel diseases like Crohn's disease and ulcerative colitis, ischemic colitis, vascular malformations, polyps, tumors, and anal issues. LGIB is typically chronic and self-limiting, though some cases are acute and require blood transfusion. The diagnostic workup depends on the patient's age and symptoms, and may involve endoscopy, imaging, or angiography to identify the source of bleeding.
This document discusses lower gastrointestinal (GI) bleeding, including:
- Causes such as angiodysplasia, carcinoma, diverticulosis, and anorectal diseases.
- Clinical evaluation involving history of presenting symptoms, physical exam, investigations to localize the source of bleeding such as colonoscopy, and management including resuscitation, treating the underlying cause, and potential surgical intervention for massive or recurrent bleeding.
- Diagnostic tools like colonoscopy, mesenteric angiography, and radionuclide scanning along with their advantages and disadvantages.
This document outlines a presentation on the pathophysiology and management of acute abdomen. It begins with definitions of acute abdomen and types of abdominal pain. Pathophysiological mechanisms including luminal obstruction, inflammation, peritonitis, ischemia and non-specific pain are described. Common causes like appendicitis, cholecystitis, bowel obstruction and perforated viscus are listed. Immediately life-threatening diagnoses of perforated viscus, bowel ischemia, ruptured abdominal aortic aneurysm and ruptured ectopic pregnancy are highlighted. Clinical assessment techniques and investigations are outlined. Management principles focusing on ABCs, fluid resuscitation and need for surgery in some cases are emphasized in the take-home message.
1. The document discusses gastrointestinal bleeding, describing its various presentations including hematemesis, melena, hematochezia, occult blood in stools, and chronic blood loss/anemia.
2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
This document discusses lower gastrointestinal bleeding, including its definition, causes, clinical presentation, risk stratification, localization techniques, and treatment approaches. The main causes of lower GI bleeding discussed are diverticular diseases, hemorrhoids, angiodysplasia, inflammatory bowel disease, and neoplasms. Initial management involves resuscitation, risk stratification, and localization of the bleeding site using techniques such as colonoscopy, radionuclide scanning, and mesenteric angiography. Treatment depends on the underlying cause but may include pharmacologic, endoscopic, angiographic, or surgical interventions.
Lower gastrointestinal bleeding (LGIB) is commonly caused by hemorrhoids but should be investigated. The most common causes of LGIB are diverticulosis, colonic arteriovenous malformations, and colitis. LGIB affects mostly the elderly, with a mean age of 63-77 years. Approximately 85% of LGIB originates in the colon. Diverticular disease is the leading specific cause, with bleeding often occurring from the sigmoid colon. Colonic arteriovenous malformations are also a major source of LGIB.
Upper gastrointestinal (UGI) bleeding can originate from the esophagus, stomach, or duodenum. The document discusses the causes, clinical presentations, associated conditions, and endoscopic findings of UGI bleeding. The major causes include peptic ulcers, esophageal or gastric varices, esophagitis, vascular ectasias, tumors, and Dieulafoy's lesions. An evaluation of UGI bleeding involves assessing severity based on history and labs, and identifying potential bleeding sources and comorbidities to guide management. Endoscopy allows visualization of the source and features to determine the risk of rebleeding.
Upper GI bleeding refers to bleeding that originates in the esophagus, stomach, or duodenum. Common causes include peptic ulcers, esophageal varices, and gastritis. Risk factors include NSAID/aspirin use and H. pylori infection. Diagnosis involves history, physical exam, endoscopy, and blood tests. Management depends on risk level and includes hemodynamic stabilization, endoscopy, and treatment of the underlying cause. Outcomes range from full recovery to mortality rates as high as 30% in severe or continuing bleeding cases.
This document discusses lower gastrointestinal bleeding, including its definition, causes, symptoms, diagnosis, and management. The most common causes of lower GI bleeding are diverticular disease and angiodysplasia. Diagnostic tests include colonoscopy, angiography, and radionuclide scanning. Colonoscopy allows for diagnosis and treatment but requires bowel prep, while angiography and scanning are less invasive but also less accurate. Management depends on the severity and cause of bleeding, and may include blood transfusions, endoscopic therapies, angiography, or surgery in severe cases.
This document discusses gastrointestinal (GI) bleeding, including:
1) GI bleeding can present as overt (visible bleeding) or occult (hidden bleeding) and can originate from the upper or lower GI tract. Common symptoms include hematemesis, melena, and hematochezia.
2) Etiologies of upper GI bleeding include esophageal varices, peptic ulcers, Mallory-Weiss tears, and Dieulafoy's lesions. Management involves endoscopy, vasoactive drugs, proton pump inhibitors, and blood transfusions.
3) Lower GI bleeding can originate from the small intestine or colon. Causes include vascular ectasias, cancers, diverticulosis, and inflammatory bowel disease
This document discusses gastrointestinal bleeding, including:
- Gastrointestinal bleeding can arise from any location in the GI tract and represents the initial symptom of GI disease in 1/3 of patients.
- Clinical presentations of GI bleeding include hematemesis, melena, hematochezia, occult bleeding, and symptoms of blood loss/anemia.
- Common causes of upper GI bleeding are peptic ulcers and esophageal varices, while diverticulosis and colon polyps are common causes of lower GI bleeding.
- The approach to a patient with GI bleeding involves stabilizing their hemodynamic status, identifying the source of bleeding, stopping active bleeding, treating the underlying cause, and preventing recurrent
This document discusses gastrointestinal bleeding, its causes, presentations, evaluation, and management. The most common causes of upper GI bleeding are varices, erosive gastritis, and peptic ulcers while the most common causes of lower GI bleeding are hemorrhoids, dysentery, polyps, and inflammatory bowel diseases. Evaluation involves history, physical exam, endoscopy, and other imaging modalities. Management depends on the severity and includes IV fluids, blood transfusions, endoscopic therapies, and angiography.
This document discusses gastrointestinal bleeding (GIB). It is classified as upper GIB, arising above the ligament of Treitz, or lower GIB, arising below. Common causes of upper GIB include peptic ulcer disease, portal hypertension, Mallory-Weiss tears, and vascular anomalies. Initial management involves fluid resuscitation and endoscopy for diagnosis and treatment. Lower GIB causes include diverticulosis, angiodyplasia, and inflammatory bowel disease. The document provides details on evaluation, diagnosis, and management of GIB.
This document discusses the approach to patients presenting with acute gastrointestinal bleeding. It begins with an overview of gastrointestinal anatomy and blood supply. It then discusses the classification, causes, and clinical presentation of upper and lower GI bleeding. The summary concludes with the key aspects of evaluating a patient with GI bleeding, including history, physical exam, labs, endoscopy, imaging, and risk stratification using the Rockall score.
This document discusses gastrointestinal bleeding (GIB). It is classified as upper GIB, which arises above the ligament of Treitz, or lower GIB, which arises below. Common causes of upper GIB are peptic ulcer disease, portal hypertension, Mallory-Weiss tears, vascular anomalies, gastritis, erosive esophagitis, and gastric cancer. Initial management involves fluid resuscitation, blood products, and endoscopy for diagnosis and treatment. Colonoscopy is often used to evaluate lower GIB.
The document discusses the approach to GI hemorrhage. It begins with the clinical presentation of GI bleeding, including symptoms of upper and lower GI bleeding. It then discusses resuscitation of patients based on bleeding severity. The causes, symptoms, and approaches to treatment of upper and lower GI bleeding are described. Diagnostic tests including endoscopy are explained. Specific causes of upper GI bleeding like peptic ulcers and varices are elaborated. Causes of lower GI bleeding including diverticular disease, angiodysplasia, and ischemia are also summarized.
The document discusses lower gastrointestinal bleeding, including its definition, causes such as diverticular disease, inflammatory bowel disease, angiodysplasia, and coagulopathy. It covers the clinical presentation, various diagnostic tests including colonoscopy, capsule endoscopy and nuclear scintigraphy. Colonoscopy is the mainstay for evaluation as it can both diagnose the bleeding source and provide therapeutic treatment in many cases.
This document discusses gastrointestinal tract bleeding. It defines upper and lower GI bleeding and provides epidemiological data. Common causes of upper GI bleeding include peptic ulcers, varices, Mallory-Weiss tears, and angiodysplasia. Lower GI bleeding is commonly caused by diverticular disease, angiodysplasia, and ischemic colitis. Management involves resuscitation, endoscopy for diagnosis and treatment, and angiography for severe or obscure bleeding. The mortality of GI bleeding remains significant.
Upper Gastrointestinal Bleeding
The document discusses upper gastrointestinal bleeding (UGIB), which refers to bleeding proximal to the ligament of Treitz. UGIB can manifest as hematemesis, melena, or blood in a nasogastric tube. The most common causes of UGIB are peptic ulcer disease, gastritis/erosions, esophagitis, and varices. Evaluation involves history, physical exam, laboratory tests, imaging like endoscopy. Endoscopy allows for diagnosis and treatment with interventions like injection, cauterization, or clips. Resuscitation, pharmacologic agents, and endoscopy are used to manage acute bleeding, while treatments like beta-blockers can prevent var
Lower gastrointestinal bleeding (LGIB) refers to blood loss originating from a site distal to the ligament of Treitz. Common causes of LGIB include hemorrhoids, diverticulosis, angiodysplasia, and anal cancers. Hematochezia is the typical presentation of LGIB. Initial workup includes examination, blood tests to check for anemia and coagulopathy, and colonoscopy for diagnosis and potential therapeutic intervention to stop bleeding. Management depends on the cause but may include conservative measures, nonsurgical options like banding or surgical procedures like hemorrhoidectomy.
Ischemic colitis is a condition caused by reduced blood flow to the colon, most commonly seen in elderly patients. It has three main phases - hyperactive, paralytic, and shock - depending on severity. Diagnosis involves blood tests, imaging like CT scans, and endoscopy. Mild cases are treated with fluids and bowel rest. More severe cases may require surgery like resection. Most patients recover fully, but complications can include chronic ischemic colitis or strictures. Prognosis depends on severity, with gangrenous ischemia carrying higher mortality.
Imaging and intervention in hemetemesisSindhu Gowdar
This document discusses various imaging modalities for evaluating gastrointestinal bleeding, including hematemesis. It provides details on angiography, computed tomography angiography, and endoscopy. The key points are:
- Endoscopy is the primary initial investigation but additional techniques like CT angiography and catheter angiography may be needed when endoscopy is negative or fails to identify the bleeding source.
- CT angiography has advantages over catheter angiography as it is more widely available, non-invasive, and allows detection of bleeding sources throughout the GI tract.
- Both endoscopy and CT angiography play important roles in evaluating GI bleeding, with endoscopy also allowing for therapeutic interventions when a source is identified.
This document provides an overview of gastrointestinal (GI) bleeding, including its causes, symptoms, diagnosis, and treatment. GI bleeding is classified as upper or lower depending on its location in the GI tract. Common causes of upper GI bleeding include peptic ulcers, gastritis, esophageal varices, and cancers. Lower GI bleeding is often caused by diverticulosis, cancers, inflammatory bowel disease, infections, angiodysplasia, polyps, and hemorrhoids. Symptoms include vomiting blood, black stools, and fatigue. Diagnosis involves medical history, physical exam, endoscopy or colonoscopy, and lab tests. Treatment depends on severity but may include IV fluids, blood transfusions, surgery, or
This document discusses gastrointestinal bleeding (GIB), including definitions of overt and occult GIB. It describes common causes of upper and lower GIB, such as peptic ulcers, esophageal varices, diverticulosis, and hemorrhoids. Evaluation involves history, exam, labs, and endoscopy. Treatment depends on the severity and location of bleeding, and may include fluid resuscitation, blood transfusions, pharmacotherapy, endoscopic interventions, angiography, and surgery.
This document discusses gastrointestinal (GI) bleeding. It begins by stating that GI bleeding is a common gastrointestinal emergency, with 50% being upper GI bleeding and 40% being lower GI bleeding. Upper GI bleeding is more common and a major cause of morbidity and mortality. The document then discusses the classification, causes, risk factors, clinical presentation, diagnosis, management including endoscopy, and prevention of both upper and lower GI bleeding. It also covers obscure GI bleeding, differentiation of upper vs. lower GI bleeding, and references.
This document discusses intestinal ischemia, which occurs when blood flow to the intestines is reduced. It can affect the small or large intestine and be caused by arterial occlusion, venous occlusion, or vasospasm. Intestinal ischemia is classified based on time of onset, symptoms, degree of blood flow compromise, and affected bowel segment. The main types are acute mesenteric ischemia, chronic mesenteric ischemia, and non-occlusive mesenteric ischemia (NOMI). Clinical features vary depending on type but may include abdominal pain, nausea, vomiting, and bloody stool. Diagnosis involves imaging like CT angiography. Treatment involves resuscitation, antibiotics, pain control, and revascularization through open surgery or endovascular techniques
This document defines and describes lower gastrointestinal bleeding. Key points:
- Lower GI bleeding occurs distal to the ligament of Treitz and is defined as abnormal bleeding into the bowel lumen. Significant bleeding is over 10ml/day.
- The lower GI tract includes the small intestine (duodenum, jejunum, ileum), large intestine (cecum, colon, rectum), and anus.
- Lower GI bleeding typically presents as hematochezia (red or dark blood in stool) or melena (dark stools). Massive bleeding causes hemodynamic instability while moderate bleeding is stable.
- Common causes include vascular abnormalities, inflammatory bowel disease, cancers, polyps, diverticular
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1. AMBO UNIVERSITY
COLLEGE MEDICINE AND HEALTH
SCIENCE
DEPARTMENT OF MEDICINE
SEMINAR PRESENTATION ON :-
GASTRO INTESTINAL BLEEDING
PREPARED BY: ABDISA GELETA
MODULATOR :DR SAMSON
2016 GC
11/25/2017 1GI bleeding
2. OUT LINE
• Introduction
• Ethiology of upper GI bleeding
• Ethiology of lower GI bleeding
• Approach to patient with GI bleeding
• Management course
11/25/2017 2GI bleeding
3. GI bleeding
• Gastrointestinal bleediing (GI bleeding), also
known as gastrointestinal hemorrhage, is all forms
of blood loss from the gastrointestinal tract.
• Bleeding is typically divided into two main
types: upper gastrointestinal bleeding and lower
gastrointestinal bleeding.
• Upper GI bleeding refers to bleeding that arises
from the GI tract proximal to the ligament of Treitz
and accounts for nearly 80% of significant blood
loss
• 20% LGIB- distal to ligament of Treitz
11/25/2017 3GI bleeding
4. Differentiation of UGIB and LGIB
4
•Hematemesis: vomiting bright red blood or blood that is
dark, like coffee grounds,Indicates upper GI bleeding
•Melena: passage of dark pitchy stools stained with blood
pigments Indicates upper GI bleeding
•Hematochezia: passage of bright red blood with stool.
Indicates lower GI bleeding
11/25/2017 GI bleeding
5. • Hematochezia usually represents a lower GI
source of bleeding, although an upper GI
lesion may bleed so briskly that blood does
not remain in the bowel long enough for
melena to develop.
• When hematochezia is the presenting symptom
of UGIB, it is associated with hemodynamic
instability and dropping hemoglobin.
11/25/2017 5GI bleeding
7. Peptic ulcer disease
• Develop due to an imbalance between aggressive
factors and protective factors, leading to an
interruption in the mucosal integrity
• Aggressive factors .Protective factor
-acid -bicarbonate
-h.pylori -mucus
-pepsin - prostaglandin
-NSAID
11/25/2017 7GI bleeding
8. Types PUD
• Gastric ulcer:
– Burning, gnawing
epigastric pain that
occurs with anything in
the stomach;
– Pain is worst after eating
(in contrast to duodenal
ulcer).
– Anorexia/weight loss,
vomiting.
– Associated with blood
type A.
• Duodenal ulcer:
– Burning, gnawing
epigastric pain that occurs
with an empty stomach
(hunger pain) and is
relieved by food or
antacids (in contrast to
gastric ulcers).
– Night time awakening
(when stomach empties).
– Nausea, vomiting.
– Associated with blood type
O.
11/25/2017 8GI bleeding
10. Esophageal Varices
• The increased pressure in the esophageal plexus
produces dilated tortuous vessels called varices.
• Variceal rupture produces massive hemorrhage
into the lumen.
•present with hematemesis, melena, or
hematochezia
11/25/2017 10GI bleeding
11. Mallory–Weiss Syndrome
• is characterized by longitudinal mucosal lacerations
(intramural dissections) in the distal esophagus and
proximal stomach, which are usually associated with
forceful retching.
Common Alcoholic patient after binge drinking
-First :- vomit food and gastric contents
-Followed by :- forceful retching & bloody vomitus.
11/25/2017 11GI bleeding
14. Erosive Gastropathy
• Endoscopically visualized subepithelial
hemorrhages and erosions
• Gastritis are mucosal lesions due to inflammatory
condition and, thus, do not cause major bleeding.
• NSAID use, alcohol intake, and stress more
aggravate
11/25/2017 14GI bleeding
15. Esophagitis
• Esophageal inflammation secondary to repeated
exposure of the esophageal mucosa to the acidic
gastric secretions in gastroesophageal reflux disease
(GERD) leads to an inflammatory response, which
can result in chronic blood loss.
11/25/2017 15GI bleeding
16. UGI TUMORS
• Acute bleeding represents a late stage of disease
when the neoplasm outgrows its blood supply and
causes mucosal ulceration.
• Bleeding can result from diffuse mucosal ulceration
or from erosion into an underlying vessel.
11/25/2017 16GI bleeding
18. Lower GI bleeding
• Bleeding that originates from sources located distal
to the Ligament of Treitz.
• Accounts for 1% of acute hospital admissions each
year.
• Much less common reason for hospitalization, when
compared with upper GI hemorrhage.
1811/25/2017 GI bleeding
19. • GI bleeding that persists or recurs without a diagnosed
etiology after the initial routine work-up is known as
Obscure GI bleeding.
• Approximately 5% of pts will have obscure GIB.
• Obscure GIB is further categorized as either:-
• Obscure occult or
• Obscure overt bleeding
• Small intestinal bleeding usually is considered under
obscure causes of GI bleeding
1911/25/2017 GI bleeding
20. possible causes of lower
gastrointestinal bleeding (LGIB
• Anatomic (diverticulosis)
• Vascular (angiodysplasia, ischemic, radiation-
induced)
• Inflammatory (inflammatory bowel disease,
infectious)
• Neoplastic
11/25/2017 GI bleeding 20
21. Diverticular disease
• Presence of symptomatic diverticula.
• Most are asymptomatic, but 3–5% will develop massive
bleeding.
• 99% of patients with these bleeding require four or fewer
units of blood before they stabilize.
• Bleeding resolves without intervention 80% of the time.
• Rebleeding occurs in 25–30% of pts after the first episode.
• If bleeding ceases spontaneously a second time, the
recurrence rate is as high as 50%. 2111/25/2017 GI bleeding
22. Vascular cause
Bowel ischemia
• Occlusion of the inferior mesenteric artery can present
with abdominal colic and rectal bleeding.
• Risk groups are the elderly people who have evidence
of generalised atherosclerosis.
Angiodysplasia
• Angiodysplasia is a diseases of the elderly in which
vascular malformations develop in the proximal colon.
• Bleeding can be acute and profuse; it usually stops
spontaneously but commonly recurs. 2211/25/2017 GI bleeding
24. Noninfectious
• IBD:- UC, CD,
GI bleeding may be the 1st presentation
Bloody diarrhea (more in ulcerative colitis)
acute hemorrhage (more likely in cd)
• Radiation colitis:
After treatment for pelvic malignancies.
Patients present with bright-red blood per rectum,
diarrhea, tenesmus, and crampy pelvic pain
2411/25/2017 GI bleeding
25. Neoplasia
• Colorectal carcinoma:
Not common but has to be ruled out in painless,
intermittent, and slow bleeding.
Frequently associated with iron deficiency anemia
• Polyps :-
more commonly, the bleeding occurs after a
polypectomy.
juvenile polyps are the second most common cause of
bleeding in patients younger than 20 years of age
• Others: lipoma, lymphoma, leiomyoma,
leiomyosarcoma
2511/25/2017 GI bleeding
27. Haemorrhoids and anal fissures
Dilated veins both from deep and superficial plexus
• Haemorrhoidal bleeding is bright red and occurs
during or after defecation.
• Types-internal and external
Anal fissure should be suspected when fresh rectal
bleeding and anal pain occur during defecation
11/25/2017 27GI bleeding
28. APPROACH TO THE PATIENT
GI BLEEDING
Goal of the evaluation:
• To assess the severity of the bleed,
• Identify potential sources of the bleed &
determine if there are conditions that may affect
subsequent management.
Initial evaluation
• Includes a history, physical examination& laboratory
tests
11/25/2017 28GI bleeding
29. History
• Abdominal pain
• Hematemesis
• Melana
• Hematochezia
• Features of blood loss: shock, anemia
• Features of underlying cause: dyspepsia, jaundice,
weight loss
• Drug history: - like
NSAIDs(Aspirin)
Anticoagulants,
•History of epistaxis or hemoptysis
11/25/2017 29GI bleeding
30. Bleeding manifestations:
• Hematemesis (red blood or coffee-ground emesis)-
UGIB
-frankly bloody emesis -moderate to severe bleeding
that may be ongoing,
-coffee-ground emesis-limited bleeding.
• melena (black, tarry stool)- UGIB(90%)
11/25/2017 30GI bleeding
31. • Hematochezia :- LGIB or if it is massive
UGIB(orthostatic hypotension)
-bright red:-left colon
-Maroon colour:-right side of colon
-Hematochezia with abdominal pain;may represent
ischemic colitis,
-Painless hematochezia:- diverticulosis and colonic
tumors
11/25/2017 31GI bleeding
32. patients can be
• Low risk patients
Self limited bleeding, young and otherwise healthy
patients ;Internal hemorrhoid
• High risk patients
hemodynamic instability, serious comorbid diseases,
persistent bleeding-promptly resuscitate and
hospitalize and need more evaluation
3211/25/2017 GI bleeding
33. Symptom assessment:
To assess the severity and potential source of bleeding,
orthostatic dizziness, confusion, angina, severe
palpitations, and cold extremities-severe bleeding
Epigastric or right upper quadrant pain
Odynophagia, dysphagia
3311/25/2017 GI bleeding
34. Emesis, retching, or coughing prior to hematemesis
Jaundice, weakness, fatigue, anorexia, abdominal
distention
Dysphagia, early satiety, involuntary weight loss,
cachexia
GI bleeding 3411/25/2017
35. • Medication History
Pay attention to:
aspirin and other NSAIDs
antiplatelet agents and anticoagulants
GI bleeding 3511/25/2017
36. • Assess comorbid illnesses
illnesses may:
-Make patients more susceptible to hypoxemia eg CAD,
pulmonary disease
-Predispose patients to volume overload eg CHF, renal
disease ;need attention during resustation
3611/25/2017 GI bleeding
37. -Result in bleeding that is more difficult to control (eg,
coagulopathies, thrombocytopenia, significant hepatic
dysfunction)-may need fresh frozen plasma or
platelets.
-Predispose to aspiration (eg hepatic encephalopathy)—
needs intubation.
GI bleeding 3711/25/2017
38. Distinguishing upper vs lower
• upper GI bleeding
– History
• Previous NSAID use
• Previous PUD
• Alcoholism
• Previous stomach surgery
• Retching/vomiting
• Weight loss
• Medications such as anticoagulants, antiplatelets
11/25/2017 GI bleeding 38
40. 11/25/2017 GI bleeding 40
• Lower GI bleeding
-History
• Previous colon cancer
• Previous colon surgery
• Known diverticulosis
• Known hemorrhoids
41. – Symptoms
• Abdominal pain or can be painless
• Hematochezia
• Melena
11/25/2017 GI bleeding 41
42. Physical examination
• Signs of hypovolemia
Resting tachycardia- Mild to moderate
hypovolemia
Orthostatic hypotension-at least 15% blood loss
Supine hypotension-at least 40% loss
• SKIN changes:
– Palmar erythema-Cirrhosis
– Purpura /Echymosis-Bleeding disorders
• Signs of dehydration (dry mucosa, sunken eyes)
• Digital rectal exam: fresh blood, occult blood may be
found.
11/25/2017 GI bleeding 42
43. Estimating Degree of Blood Loss RR, HR, and BP can be used
to estimate the degree of blood loss/hypovolumia
Class I Class II Class III Class IV
Volume Loss (ml)
Or %
0-750 or
Up to 15%
750-1500 or
15-30%
1500-2000 or
30-40%
>2000 or
>40%
RR 14-20 20-30 30-40 >40
HR <100 >100 >120 >140
BP unchanged unchanged reduced reduced
Urine Output
(ml/hr)
>30 20-30 5-15 Anuric
Mental State Restless Anxious Anxious/confuse
d
Confused/
lethargic
GI bleeding 4311/25/2017
44. Lab Diagnosis
• CBC, blood group
-(CBC, WBC, HCT/Hb, platelet count…)
-Hb may be normal initially
-CBC should be checked frequently(q4-6h) during
the first day.
-Patients with slow, chronic GIB may have very low
hemoglobin values despite normal blood pressure
and heart rate.
11/25/2017 GI bleeding 44
45. • Blood chemistry
-BUN/creatinine >20:1 UGIB
• NG tube lavage to exclude UGIB
• LFT
• Coagulation studies
• ECG and cardiac enzymes
• Stool examination for- parasites, blood cells, Occult
blood in chronic occult blood loss
• GI Endoscopy, sigmoidoscopy: Valuable for
visualization biopsy taking and endoscopic treatment
GI bleeding 4511/25/2017
46. Nasogastric Lavage
• This procedure may confirm:-
-Recent bleeding (coffee ground appearance)
-Active bleeding (red blood in the aspirate)
-nonbloody bilious fluid-pylorus is open and that
there is no active upper GI bleeding distal to the
pylorus.
-Negative lavage-bleeding may be distal to closed
pylorus
-Lack of blood in the stomach (active bleeding
less likely but does not exclude an upper GI
lesion11/25/2017 GI bleeding 46
47. GI bleeding 47
to remove particulate matter, fresh blood, and
clots from the stomach to facilitate endoscopy.
11/25/2017
48. Endoscopy
• Initial diagnostic examination for all patients
presumed to have UGIB.
• Endoscopy should be performed immediately
after:-
-Endotracheal intubation (if indicated)
-Hemodynamic stabilization, and
-Adequate monitoring in ICU is achieved
• Used: Diagnostic and Therapeutic(Hemostasis,
luminal restoration (dilation, ablation, stenting),
lesion removal (e.g., polypectomy), percutaneous
endoscopic gastrostomy)
11/25/2017 GI bleeding 48
49. Endoscopy cont…
• Urgent indication
-Shock
-Hct < 30
-Suspected variceal hemorrhage
-Recurrence of bleeding from unknown source
• Contra indication:- acute MI, , agitation,
circulatory imbalance
• Complication: aspiration, worsening of bleeding,
perforation,
11/25/2017 GI bleeding 49
51. Colonoscopy
-The gold standard for diagnosis of colonic mucosal disease
-Done for pts who don’t respond for resuscitation
-Gives good diagnosis yield if it is done with in 6-12hrs of
bleeding---Identifies lesion in 75 % or more
-Bowel preparation with purgatives 2-4hrs before the
procedure
-Can provide endoscopic therapy
-Complications 0.5-1 %
GI bleeding 5111/25/2017
52. Imaging
• Chest X-Ray-Chest radiographs should be ordered to
exclude aspiration pneumonia and effusion.
• Abdominal X-Ray- upright and supine films should be
ordered to exclude perforated viscus and ileus.
GI bleeding 5211/25/2017
55. Management of GI bleeding
There are steps in GI bleeding Mgt
• Initial assessment
• Resuscitation measures
• Identifying source of bleeding
• Institution with specific therapy
GI bleeding 5511/25/2017
56. Management of GI bleeding
Patient Assessment
If the patient:
• Hemodynamically stable OPD
• No evidence of active bleeding
or
If the patient:
• Is hemodynamically unstable
• Is continuously bleeding ICU
• Hct drops by 6%
GI bleeding 5611/25/2017
57. Resuscitation
• Airways
Massive hematemesis +
mental obtundation
-Intubation
• Breathing
Administer oxygen with IN
cannula,or facemask or
endotracheal tube
• Circulation
-Fluid resuscitation
crystalloids (NS or RL)
• Blood transfusion
If Hb < 7 or actively
bleeding Hb goal =10
NB: cautions in high risk
patient
• Correct coagulopathy
GI bleeding 5711/25/2017
58. Specific Rx Measures- Upper GI
. Esophageal varices
-Endoscopy: Best therapy-band ligation & sclerotherapy
-Somatostatin, octereotide 50–100 µg/h IV infusion
-Vasopressin
-Propranolol
-Antibiotics
-Transjugular intrahepatic portosystemic shunt( TIPS)
GI bleeding 5811/25/2017
59. PUD
-PPI: pantoprazole 80mg iv bolus then 8mg/hr infusion,
if no bleeding in 24 hrs switch to PO Omeprazole
20mg/day
-Drugs enhancing mucosal defenses: prostaglandin
analogues (e.g misoprostol)
-Antacids –promote ulcer healing through stimulation
gastric defense mechanism
-Therapy of H.Pylori
(omeprazole20mg,amoxacillin1000mg,clarithromicin
500mg all po BID *10days)
GI bleeding 5911/25/2017
60. Surgical Mx GIB
UGIB:-indications are perforation, uncontolled
hemorrhage ,GOO and recurrent ulcer following gastric
surgery.
LGIB:-persitent or recurrent bleeding from wide variety
of colonic sources of GI bleeding that can not be
treated medically / endoscopically
GI bleeding 6011/25/2017
61. REFERENCES
-Harrison principles of internal medicine 18th edition.
-Up to date 21.6
-Cecil - Textbook of Medicine
GI bleeding 6111/25/2017
bismuth salts
used to treat acid stomach and formerlyused in the treatment of syphilis
Hepatic encephalopathy or portosystemic encephalopathy (PSE) represents a reversible impairment of neuropsychiatric function associated with impaired hepatic function. Despite the frequency of the condition, we still lack a clear understanding of pathogenesis. Nevertheless, decades of experience have suggested that an increase in ammonia concentration is implicated and that there may be a role for inhibitory neurotransmission through gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS) and changes in central neurotransmitters and circulating amino acids.
Postural hypotention (15% of bood ) ,supine Hypotention (40%) ,shock
Blood for cross match, BT should be indivdualized high risk px
INR =international normalizing ratio are measures of the extrinsic pathway of coagulation.
FFP= FRESH FROYHEN PLASMA
TIPS percutaneous approach using an expandable metal stent, which is advanced under angiographic guidance to the hepatic veins and then through the substance of the liver to create a direct portocaval shunt.
sclerotherapy /sklərəυθerəpi/ noun the treatment of a varicose vein by injecting a sclerosant agent(an irritating liquid injected into tissue to
harden it) into the vein, and so encouraging the blood in the vein to clot
Octreotide is a long-acting analog of somatostatin