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.
A 72-year-old woman presented to the emergency room with coffee ground emesis and melena. Laboratory tests showed a hemoglobin of 8.1. Physical exam found melenic stool. The patient has a history of hypertension, diabetes, coronary artery disease, and recent myocardial infarction. This suggests a diagnosis of acute gastrointestinal bleeding, which will require endoscopy, medication treatment including PPIs and antibiotics, and possible blood transfusion or surgery.
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.
UPPER GI BLEEDING CAUSES RISK FACTORS AND TREATMENTNadyMchiz
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, epidemiology, etiology, clinical presentation, principles of management, and specific treatments. UGIB refers to bleeding from a source above the ligament of Treitz and is a common condition affecting around 100 per 100,000 adults, with a higher incidence in males. The most common etiologies are peptic ulcers, varices, Mallory-Weiss tears, and hemorrhagic gastropathy. Clinical presentation depends on the cause but may include hematemesis, melena, or hematochezia. Management focuses on stabilizing the patient and investigating the source of bleeding via endoscopy. Variceal bleeding is
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 outlines the principles and management of upper gastrointestinal tract bleeding. It begins with introducing common causes such as peptic ulcers, esophagitis, and variceal bleeding. It then discusses the initial assessment and resuscitation of patients, including classifying hemorrhagic shock. Risk stratification scores are described to predict the need for interventions. Specific therapies for causes like peptic ulcers, stress gastritis, and variceal bleeding are covered. Endoscopy is highlighted as the primary diagnostic and therapeutic tool. The conclusion emphasizes the multidisciplinary nature and importance of determining the bleeding source for directing treatment.
This document provides an overview of the practical approach to managing non-variceal upper gastrointestinal bleeding. It discusses initial considerations including risk stratification, definitions, differential diagnosis, history and physical exam findings. It then covers resuscitation including fluid management and transfusion thresholds. The role of endoscopy is explained, including optimal timing and findings requiring endoscopic therapy. Risk scores for predicting outcomes and need for intervention are presented. Management strategies before and after endoscopy are outlined.
A 72-year-old woman presented to the emergency room with coffee ground emesis and melena. Laboratory tests showed a hemoglobin of 8.1. Physical exam found melenic stool. The patient has a history of hypertension, diabetes, coronary artery disease, and recent myocardial infarction. This suggests a diagnosis of acute gastrointestinal bleeding, which will require endoscopy, medication treatment including PPIs and antibiotics, and possible blood transfusion or surgery.
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.
UPPER GI BLEEDING CAUSES RISK FACTORS AND TREATMENTNadyMchiz
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, epidemiology, etiology, clinical presentation, principles of management, and specific treatments. UGIB refers to bleeding from a source above the ligament of Treitz and is a common condition affecting around 100 per 100,000 adults, with a higher incidence in males. The most common etiologies are peptic ulcers, varices, Mallory-Weiss tears, and hemorrhagic gastropathy. Clinical presentation depends on the cause but may include hematemesis, melena, or hematochezia. Management focuses on stabilizing the patient and investigating the source of bleeding via endoscopy. Variceal bleeding is
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 outlines the principles and management of upper gastrointestinal tract bleeding. It begins with introducing common causes such as peptic ulcers, esophagitis, and variceal bleeding. It then discusses the initial assessment and resuscitation of patients, including classifying hemorrhagic shock. Risk stratification scores are described to predict the need for interventions. Specific therapies for causes like peptic ulcers, stress gastritis, and variceal bleeding are covered. Endoscopy is highlighted as the primary diagnostic and therapeutic tool. The conclusion emphasizes the multidisciplinary nature and importance of determining the bleeding source for directing treatment.
This document provides an overview of the practical approach to managing non-variceal upper gastrointestinal bleeding. It discusses initial considerations including risk stratification, definitions, differential diagnosis, history and physical exam findings. It then covers resuscitation including fluid management and transfusion thresholds. The role of endoscopy is explained, including optimal timing and findings requiring endoscopic therapy. Risk scores for predicting outcomes and need for intervention are presented. Management strategies before and after endoscopy are outlined.
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 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 causes, or using vasoactive agents, balloon tamponade, or endoscopic therapies for variceal bleeding.
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 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 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
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
This document provides an overview of upper gastrointestinal hemorrhage. It discusses the initial assessment and resuscitation of patients, including fluid resuscitation and blood transfusions. The identification of the source of bleeding is important, and endoscopy is the gold standard investigation. The main causes of upper GI bleeding are discussed, including peptic ulcer disease, variceal bleeding, and Mallory-Weiss tears. Treatment options are outlined for each cause, including pharmacologic, endoscopic, interventional, and surgical approaches.
This document provides an overview of upper gastrointestinal hemorrhage. It defines upper GI hemorrhage as bleeding in the upper gastrointestinal tract below the ligament of Treitz. The most common causes are listed as peptic ulcer, portal hypertension, gastritis, and esophageal varices. Patients typically present with hematemesis, melena, or hematochezia. Diagnosis involves physical examination, lab tests, and endoscopic evaluation. Initial management focuses on stabilizing the patient and determining the source and rate of bleeding in order to guide specific treatment.
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
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 provides an overview of upper gastrointestinal bleeding, including:
- The definition, incidence, mortality, and common causes of upper GI bleeding. The most common causes are gastric and duodenal ulcers, esophagitis, and esophageal varices.
- Principles of management including initial assessment, resuscitation, localization of bleeding site usually through endoscopy, and risk stratification to determine need for inpatient care or intervention.
- Endoscopy is the gold standard for diagnosis and treatment. The Forrest classification guides prognosis and need for endoscopic therapy based on stigmata of recent hemorrhage seen. Proton pump inhibitors are commonly used for prevention of rebleeding.
This document provides information on the assessment and management of upper GI bleeding. It defines types of upper GI bleeding and outlines a stepwise approach. Initial steps include resuscitation, transfusion if needed, and risk stratification. Diagnosis involves history, exam, nasogastric lavage and endoscopy. Endoscopy allows identification of the bleeding source and endoscopic treatment. Surgery is considered if bleeding persists after other measures. The document reviews causes of bleeding and management of peptic ulcer bleeding specifically.
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.
CLD Diagnosis and management………………..pptxhamid15abass
This document discusses the definition, causes, clinical presentation, and management of complications of chronic liver disease (CLD). It defines CLD as progressive liver destruction over 6 months leading to fibrosis and cirrhosis. Common complications include esophageal variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Causes include alcohol, viral hepatitis, NAFLD/NASH, and genetic/autoimmune conditions. Clinical features depend on whether the cirrhosis is compensated or decompensated. Management involves treating the specific complications, such as band ligation for esophageal varices, diuretics and albumin for ascites, and antibiotics for spontaneous bacterial periton
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 provides an outline of a lecture on upper gastrointestinal tract bleeding. It begins with definitions and discusses the epidemiology, causes, clinical presentation, diagnosis, treatment, complications, and prognosis of upper GI bleeding. The most common causes are bleeding peptic ulcers, erosive gastritis/esophagitis, and variceal bleeding from liver cirrhosis. The clinical presentation depends on features of blood loss and the underlying cause. Diagnosis involves history, physical exam, and investigations like blood tests, abdominal ultrasound, and upper endoscopy. Treatment involves resuscitation, transfusions, medications, and procedures depending on the identified cause. Complications can be from blood loss, treatment, or the underlying condition. Pro
This document discusses gastrointestinal bleeding in children. It notes that GI bleeding accounts for 10-20% of pediatric gastroenterology referrals and around 0.4% of PICU admissions are due to life-threatening GI bleeding. The presentation, classification, causes, diagnostic workup, and treatment of upper and lower GI bleeding in neonates, infants, and children are described in detail over multiple sections. Key points include distinguishing the source and severity of bleeding, identifying specific etiologies, and managing bleeding through supportive care, endoscopic procedures, medications, and surgery as needed.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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 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 causes, or using vasoactive agents, balloon tamponade, or endoscopic therapies for variceal bleeding.
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 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 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
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
This document provides an overview of upper gastrointestinal hemorrhage. It discusses the initial assessment and resuscitation of patients, including fluid resuscitation and blood transfusions. The identification of the source of bleeding is important, and endoscopy is the gold standard investigation. The main causes of upper GI bleeding are discussed, including peptic ulcer disease, variceal bleeding, and Mallory-Weiss tears. Treatment options are outlined for each cause, including pharmacologic, endoscopic, interventional, and surgical approaches.
This document provides an overview of upper gastrointestinal hemorrhage. It defines upper GI hemorrhage as bleeding in the upper gastrointestinal tract below the ligament of Treitz. The most common causes are listed as peptic ulcer, portal hypertension, gastritis, and esophageal varices. Patients typically present with hematemesis, melena, or hematochezia. Diagnosis involves physical examination, lab tests, and endoscopic evaluation. Initial management focuses on stabilizing the patient and determining the source and rate of bleeding in order to guide specific treatment.
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
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 provides an overview of upper gastrointestinal bleeding, including:
- The definition, incidence, mortality, and common causes of upper GI bleeding. The most common causes are gastric and duodenal ulcers, esophagitis, and esophageal varices.
- Principles of management including initial assessment, resuscitation, localization of bleeding site usually through endoscopy, and risk stratification to determine need for inpatient care or intervention.
- Endoscopy is the gold standard for diagnosis and treatment. The Forrest classification guides prognosis and need for endoscopic therapy based on stigmata of recent hemorrhage seen. Proton pump inhibitors are commonly used for prevention of rebleeding.
This document provides information on the assessment and management of upper GI bleeding. It defines types of upper GI bleeding and outlines a stepwise approach. Initial steps include resuscitation, transfusion if needed, and risk stratification. Diagnosis involves history, exam, nasogastric lavage and endoscopy. Endoscopy allows identification of the bleeding source and endoscopic treatment. Surgery is considered if bleeding persists after other measures. The document reviews causes of bleeding and management of peptic ulcer bleeding specifically.
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.
CLD Diagnosis and management………………..pptxhamid15abass
This document discusses the definition, causes, clinical presentation, and management of complications of chronic liver disease (CLD). It defines CLD as progressive liver destruction over 6 months leading to fibrosis and cirrhosis. Common complications include esophageal variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Causes include alcohol, viral hepatitis, NAFLD/NASH, and genetic/autoimmune conditions. Clinical features depend on whether the cirrhosis is compensated or decompensated. Management involves treating the specific complications, such as band ligation for esophageal varices, diuretics and albumin for ascites, and antibiotics for spontaneous bacterial periton
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 provides an outline of a lecture on upper gastrointestinal tract bleeding. It begins with definitions and discusses the epidemiology, causes, clinical presentation, diagnosis, treatment, complications, and prognosis of upper GI bleeding. The most common causes are bleeding peptic ulcers, erosive gastritis/esophagitis, and variceal bleeding from liver cirrhosis. The clinical presentation depends on features of blood loss and the underlying cause. Diagnosis involves history, physical exam, and investigations like blood tests, abdominal ultrasound, and upper endoscopy. Treatment involves resuscitation, transfusions, medications, and procedures depending on the identified cause. Complications can be from blood loss, treatment, or the underlying condition. Pro
This document discusses gastrointestinal bleeding in children. It notes that GI bleeding accounts for 10-20% of pediatric gastroenterology referrals and around 0.4% of PICU admissions are due to life-threatening GI bleeding. The presentation, classification, causes, diagnostic workup, and treatment of upper and lower GI bleeding in neonates, infants, and children are described in detail over multiple sections. Key points include distinguishing the source and severity of bleeding, identifying specific etiologies, and managing bleeding through supportive care, endoscopic procedures, medications, and surgery as needed.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Clinical presentation
Resuscitation
History and physicsl examination
Labs and diagnostic tests
UGI BLEED
Causes and description
LGI BLEED
Causes and description
CONTENTS
3. Clinical Presentation of GI bleeding
• Occult bleeeding
• Vomiting of fresh or old blood
• Proximal to Treitz ligament
• Bright red blood = significant
bleeding
• Coffee ground emesis = no active
bleeding
• Passage of black & foul-smelling stools
• Usually upper source - may be right colon
• Passage of bright red blood from rectum If
brisk & significant > UGI source
• Bleeding not apparent to patient
May lead to dyspnea, AP & even MI
• Hematemesis
• Melena
• Hematochezia
4. Bleeding severity Vital Signs Blood loss (%)
Minor Normal < 10 %
Moderate Postural
(Orthostatic hypotension)
10 - 20 %
Massive Shock 20 - 25 %
(Resting hypotension)
Assessing the severity of bleeding
First step
5. Resuscitation
Proportional to bleeding severity
• 2 large-bore IV catheters: Normal saline - Ringer lactate
• Oxygen by nasal cannula or facemask
• Monitoring of vital signs & urine output
• Blood Transfusion:Ht raised to Elderly: 30 %
Young: 20- 25 %
PHT: 27-28 %
• Fresh frozen plasma & platelet transfusion
If transfusion of > 10 units of packed red blood cells
6. Symptoms of UGI bleeding
Melenic or melenic stools- black tarry and foul smelling stools or dark
coloured stools
Hematemesis
Red hematemesis- vomiting of fresh blood
Coffee ground hematemsis-vomiting of blood altered by stomach acids and
enzymes
Dyspepsia
Heartburn or Epigastric pain
Abdominal pain
Dysphagia
Jaundice
Weight loss
Syncope
Pallor
7. Symptoms of LGI Bleed
• Hematochezia-fresh blood in stools may be due to hemorrhoids or
anal fissures
• Bloody diarrhoea is typical of colitis, inflammation of colon
• Febrile episodes
• Hypovolemic shock or dehydration
• Abdominal cramps or pain
• Hypotension
• Pallor
8. • Elderly
• Young
• < 30 years
Diverticula - Angiodysplasia - Cancer
Peptic ulcer - Varices - Esophagitis
Meckel diverticula
Bleeding from similar causes
Aortoenteric fistula
• Previous bleeding
• Aortic surgery
• Known liver disease Esophageal or gastric varices
• NSAIDs
• Retching
• Non GI sources
Mallory-Weiss tear
Especially from nasopharynx
9. History
• Duration and quantity of bleeding
• Associated symptoms
• Previous history of bleeding
• Current medications
• Alcohol
• NSAID ASA use
• Allergies
• Associated medical illness
• Previous surgeries
10. History of bleed
• Hematemesis usually occurs with bleeding of esophafus, stomach and
proximal small bowel
• Melena will result from the presence of approximately 150-200ml of
blood in the GI tract for a prolonged period
• FALSE POSITIVE- Associated with the ingestion of certain fruits,
vegetables or red meat
• Hematochezia- or bloody stool, it’s often LGIB
• Could be due to a brick UGIB with rapid transit time through the
bowel.
• A more proximal source of significant bleeding must be excluded
before assuming the bleeding is from the lower GI tract
24. Age
Tetrad
Prognosis
Complications
Prepubertal boys (6 m - 6 years)
Can occurs in adults
Purpuric rash: feet - buttocks - legs
Colicky abdominal pain - bloody diarrhea
Arthralgia
Glomerulonephritis
Self-limited
Rapidly progressive renal failure
GI hemorrhage
25.
26.
27. • Hematocrit
• Elevated BUN
May not reflect blood loss accurately
Not correlated to creatinine level
Breakdown of blood proteins to urea
Mild reduction of GFR
• Iron deficiency anemia
• LowMCV
• Low ferritin level
28. • Test stools for occult blood, rectal examination
• Upper GI endoscopy
• Colonoscopy
• Small bowel endoscopy
• Capsule endoscopy & double balloon enteroscopy
• Barium radiograph
• Radionuclide imaging
• Angiography
• Miscellaneous tests: abdominal US or CT
29. The scores
• Rockall score- score less than 3 is good prognosis, more than 8
carries high risk of mortality
• Glasgow Blatchford Bleeding Score
• AIMS65 Score
32. • Most frequent cause of UGI bleeding (50%)
• Especially high on gastric lesser curvature
or postero-inferior wall of duodenal bulb
• Most ulcer bleeding is self-limited (80%)
34. Stage Characteristics Rebleeding
Ia Jet arterial bleeding 90%
lb Oozing 50 %
Ila Visible Vessel 25 - 30 %
Ilb Adherent clot 10- 20%
Ile Black spot in ulcer crater 7 - 10%
III Clean base ulcer 3- 5 %
Forrest's classification for PU bleeding
35.
36. Treatmen
t of
bleeding
PU
• Pharmacological
• Endoscopic
• Surgical
PPI 80 mg IV bolus
8mg / hr / 72 hours IV infusion
Injection (epinephrine 1/10.000)
Monopolar coagulation
Bipolar coagulation
Heater probe
Hemoclips
Argon plasma coagulation
When endoscopic treatment fails
37. Summary of
therapy of
bleeding PU
• Patients must be adequately resuscitated
• UGI endoscopy is the primary diagnostic modality
• Intubation if severe bleeding or altered mental status
• Endoscopic therapy indicated in high risk lesions
Combine 2 methods of endoscopic treatment
• IV PPI should be used in high risk patients
38.
39. New classification of esophageal varices
• Small Varices:
• Large Varices:
<5mm
>5mm
40. Gastro-Oesophageal Varices
Type I Along lesser curve
Type II To gastric fundus
Isolated Gastric Varices
Type I
Type II
Fundal
8% 2 "
Ectopic
41. Predictive factors for risk of bleeding
North Italian Endoscopic Club Index
• Variceal size
• Severity of liver disease
• Red signs
Best predictor of bleeding
Expressed by Child-Pugh
On the varices
42. Category 1 2 3
Bilirubin (mg/dl) <2 2-3 >3
Albumin (g/1) > 35 2 8 - 3 5 <28
Ascites Absent Mild- Moderate Severe
Encephalopathy 0 1-11 III- IV
INR < 1.7 1.7-2.3 > 2.3
(70%) (40- 70%) (< 40%)
Class A: 5-6 Class B: 7 - 9 Class C: 10 -15
43. 0.957 x Loge (creatinine mg/dL)
+
0.378 x Loge (bilirubin mg/dL)
+
1.120 x Loge (INR)
+
0.643*
Multiply score by 10 & round to nearest whole number
Laboratory values < 1.0 are set to 1.0
Maximum creatinine within MELD score: 4.0 mg/dl
Dialysis twice/week prior to creatinine test: creatinine 4.0 mg/dl
* 0.643 for etiology to make score comparable to previous published data
44. Treatment of acute variceal bleeding-1
• Best approach is combined use of:
- Pharmacological agent started from admission &
- Endoscopic procedure
• Terlipressin & somatostatin preferable if available
Octreotide, vasopressin + nitroglycerin may be used
• Drug therapy maintained for at least 48 h
5 day therapy recommended to prevent early rebleeding
45. Treatment of acute variceal bleeding-2
• Bleeding EV
Band ligation is the endoscopic treatment of choice
Sclerotherapy may be used
• Bleeding GV
Obturation with cyanoacrylate
• TIPS
Rescue procedure if medical & endoscopic tt fails
Bleeding from GV may require earlier decision for TIPS
46. Treatment of acute variceal bleeding-3
• Shunt surgery
Mesocaval graft shunts or traditional portacaval shunts
may be an alternative to TIPS in Child A patients
• Blood transfusion
Done cautiously using packed red cells (Ht: 25 - 28 %)
Plasma expanders to maintain hemodynamic stability
• Prophylaxis of infection
Given to all patients (norfloxacin 400 mg /12 hours)
47.
48.
49.
50. Causes of bleeding in PHT
• Esophageal varices
• Gastric varices
• Ectopic varices
• Portal hypertensive gastropathy
51.
52.
53. 5- 10 % of UGI bleeding
Typically in gastric mucosa
Stop spontaneously in 80-90%
Not bleeding: discharge promptly
Active bleeding: injection - banding
63. SYMPTOMS:
• Melena: refers to dark black, tarry feces (>100-mL blood required for
one melenic stool) usually indicates bleeding proximal to ligament of
Treitz but may be as distal as ascending colon.
• Hematochezia: passage of bright red or maroon rectal
bleeding( indicating fresh blood) through the anus path, usually in or
with stools
• Symptoms of blood loss: e.g., light-headedness or shortness of
breath.
• Other associated symptoms
include: hypotension, tachycardia, angina, syncope, weakness, confusi
on, shock
64. Things to note in history and examination:
• History should include whether the bleeding is recurrent or sporadic
• Associated symptoms
• Detailed review of the patient's medications including, antiplatelets, anticoagulants, and NSAIDs
and past surgical history.
•The family history of colon cancer or inflammatory bowel disease (IBD) should also be noted.
•The presence of abdominal pain, especially if severe and associated with rebound tenderness or
involuntary guarding, raises concern for perforation. If any signs of an acute abdomen are present,
further evaluation to exclude a perforation is required prior to endoscopy.
• Digital rectal examination (DRE) inspect for hematochezia and anorectal pathology, such as
hemorrhoids.
65. Investigations:
• Complete blood count (CBC)
• Electrolyte evaluation
• Liver function tests
• Lactate levels
• Coagulation studies if the patient is on medications that would cause
them to be coagulopathic
• Lab work can revealpatients with microcytic hypochromic anemia due
to chronic blood loss
66. Algorithm for management:
The follow flowchart provides a template for care for a patient present with a lower GI bleed
67. Severe acute lower gastrointestinal bleeding
• This presents with profuse red or maroon diarrhoea and with hypovolaemic shock.
• If available, CT angiography should be performed initially to localise the site of blood
loss.
• If the bleeding source is identified, then catheter angiography with embolisation should
be performed.
• If no source of bleeding is found then a colonoscopy should be performed.
• Some patients presenting with an apparent severe lower GI bleed are ultimately found to
have a significant upper GI bleed.
68. Etiologies for severe acute bleeds:
Diverticular disease:
• Most common with up to two-thirds of cases being classified as severe.
• Bleeding from diverticular disease is often due to erosion of an artery within the mouth of a diverticulum.
• Multiple endoscopic options are available, with endoscopic clipping either alone or after the injection of
dilute adrenaline (epinephrine).
Angiodysplasia
• It's a disease of older adults, in which vascular malformations develop within the GI tract, commonly in the
caecum.
• Bleeding can be acute and profuse; it usually stops spontaneously, but commonly recurs.
• Colonoscopy may reveal characteristic vascular spots and, in the acute phase, angiography can show
bleeding into the intestinal lumen and an abnormal large, draining vein.
• The treatment of choice is endoscopic thermal ablation, but resection of the affected bowel may be
required if bleeding continues.
69. Bowel ischaemia
• Due to occlusion of the inferior mesenteric artery can present with abdominal colic and
rectal bleeding.
• It should be considered in patients (particularly older patients) who have
evidence of generalised atherosclerosis.
• Common areas are watershed areas of the colon: splenic flexure and rectosigmoid
junction
• The diagnosis is made at colonoscopy. Resection is required only in the presence of
peritonitis.
Meckel’s diverticulum
• A diverticulum with ectopic gastric epithelium may ulcerate and erode into a major
artery.
• The diagnosis should be considered in children or adolescents who present with profuse
or recurrent lower gastrointestinal bleeding.
• A Meckel’s 99m Tc-pertechnetate scan is sometimes positive, but the diagnosis
is commonly made only by laparotomy, at which time the diverticulum is excised.
70. Chronic lower gastrointestinal bleed:
• This can occur at all ages and is usually due to haemorrhoids or anal fissure.
• Haemorrhoidal bleeding is bright red and occurs during or after defecation. Proctoscopy
can be used to make the diagnosis, but individuals who have altered bowel habit and
those who present over the age of 40 years should undergo colonoscopy to exclude
coexisting colorectal cancer.
• Anal fissure should be suspected when fresh rectal bleeding and anal pain occur during
defecation.