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.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Lecture on abdominal trauma during Basic Life Support 2018 course in Sibu Hospital. Encompasses blunt and penetrating trauma, principles and tips of management
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Lecture on abdominal trauma during Basic Life Support 2018 course in Sibu Hospital. Encompasses blunt and penetrating trauma, principles and tips of management
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Piles - Also called Haemorrhoids and homeopathy treatmentPranav Pandya
haemorrhoids are vascular structures in the anal canal. Normally they are cushions that help with stool control. They become piles when swollen or inflamed.
Haemorrhoids is one of the commonest cause of lower GI bleed. Understanding the pathophysiology is important for planning a successful treatment. A thorough check up is essential before offering surgical treatment as this condition could herald the presense of a malignant lesion higher up.
Haemorrhoids are small, blood-filled swellings caused by dilated varicose veins. Initially, they are located just inside the anus (internal haemorrhoids) but can sometimes protrude (external haemorrhoids). Haemorrhoids are not dangerous.
Constipation and prolonged straining when using the toilet are thought to contribute to the formation of haemorrhoids by increasing the pressure in the veins.
What are the symptoms of haemorrhoids?
Haemorrhoids may be present for many years but remain undetected until symptoms appear. They can cause anal bleeding and itching and also pain and discomfort.
Normally, the bleeding is limited to small stains of fresh blood on the toilet paper, but more severe bleeding can sometimes be present when stools are passed.
A lump may also be felt in the anus and large haemorrhoids give a sensation that the bowel hasn't emptied completely.
If you observe blood in your stools, and have the symptoms mentioned above, you should visit your doctor for a check-up.
If haemorrhoids are present, the doctor will then perform an examination to find out if there are any other possible causes of the bleeding that may be more serious.
The doctor will feel the anal canal by digital rectal examination and may go on to inspect the mucous membrane of the rectum and lower part of the large intestine using an examination tube called a proctoscope or sigmoidoscope.
How are haemorrhoids treated?
Some haemorrhoids can get better without medical treatment. This can happen if they are caused by constipation. The doctor may recommend a change of diet with the addition of more fibre and roughage particularly green vegetables, fresh fruit, wholegrain cereals and bran. Drinking 8 to 10 glasses of fluid daily is advisable.
The person is also told to avoid straining when passing a bowel motion. Nobody should strain to push out a stool. The feet can be placed on a low foot stool to aid the bowel movement. Sitting in a shallow bath of hot water for 15 minutes several times a day, will reduce the pain.
In the case of a pile protruding from the back passage, which has become swollen and painful, a day's bed rest with an ice pack applied to the anal area should be helpful.
A pack of frozen peas wrapped in a tea towel is ideal for this purpose. Never allow the ice to come directly into contact with the skin and only use this treatment for 20 minutes in an hour for a limit of three hours a day.
Relatively minor haemorrhoids can be treated using creams available directly from your local pharmacy or on prescription. A few days' treatment is usually enough, and then the irritation will settle spontaneously.
More severe cases need to be treated by a specialist.
One possible treatment is rubber band ligation. Rubber band ligation can be performed in the doctor's surgery or outpatient clinic and does not require hospital admission.
The procedure involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2. DEMARCATION OF UPPER AND
LOWER GUT
The World Organization of Gastroenerologists defines
acute upper GI bleeding as:
The anatomic cut-off for upper GI bleeding is
the ligament of Treitz, which connects the
fourth portion of the duodenum to the splenic
flexure of the colon.
4. Adults with acute massive GI Bleeding
Duodenal Ulcer (30-37%)
Gastric Ulcer (19-24%)
Esophageal Varices (6-10%)
Gastritis or Duodenitis (5-10%)
Esophagitis or esophageal ulcer (5-10%)
Mallory-Weiss tear (3-7%)
Gastrointestinal malignancy (1-4%)
5.
Dieulafoy's Lesion (1%)
Artery at gastric fundus may bleed heavily
Difficult to identify on endoscopy
Gastric antral vascular ectasia (0.5 to 2%)
Longitudinal erythematous stripes on gastric mucosa
Known as Watermelon stomach
Arteriovenous malformation
Angiodysplasia of stomach or duodenum,
6. Adults with chronic intermittent
GI Bleeding
Gastritis (18 to 35%)
Esophagitis (18 to 35%)
Gastric Ulcer (18 to 21%)
Duodenal Ulcer (3 to 15%)
Angiodysplasia (5 to 23%)
Gastric Cancer
7. Adults - most commonly missed upper
GI sources
Large Hiatal Hernia Erosions
Arteriovenous malformation
Peptic Ulcer Disease
12. HISTORY
Has the patient been vomiting or retching before
the episode of haematemesis? -> Mallory-Weiss
tear
Enquire about the colour of the vomitus
Was there a previous incident of peptic ulcer or
haematemesis/melaena?
Heartburn -> Reflux oesophagitis
Drug history (including aspirin and over the
counter medicines -> peptic ulcer)
Alcohol -> Liver failure -> oesophageal varices ->
upper GI bleed
13. ASSESSMENT
One should first determine the amount of blood
loss, and the site of bleeding.
The measurement of vital signs provides the only
accurate assessment of blood loss (orthostatics, heart
rate, complaints of weakness or dizziness, syncope).
An NG tube should be placed as part of the
assessment. The gastric lavage may aid the endscopist
to obtain a clear view of the bleeding site.
14. PHYSICAL EXAMINATION
Vital signs, in order to determine the severity of
bleeding and the timing of intervention
Abdominal and rectal examination, in order to
determine possible causes of hemorrhage
Assessment for portal hypertension and stigmata
of chronic liver disease in order to determine if
the bleeding is from a variceal source.
15. DIAGNOSIS
Sometimes, the source can be naso-or
oropharyngeal. A careful exam of the nares
and oral pharynx should be done.
The presence of "coffee ground emesis
represents blood altered by gastric contents
and usually means that there has been slow
bleeding from the region between the
esophagus and the duodenum.
16.
A positive NG tube aspirate for blood usually
signifies that the site of bleeding is proximal to
the ligament of Treitz.
Other characteristics of upper GI bleeding are
elevated BUN and hyperactive bowel
sounds.
The source of bleeding can be identified in 90%
of cases if endoscopy is done within the first 24
hours.
17. Upper GI Bleeding Score
Criteria
Blood Urea Nitrogen (BUN)
BUN 18.2 to 22.4 mg/dl: Score 2
BUN 22.4 to 28 mg/dl: Score 3
BUN 28 to 70 mg/dl: Score 4
BUN >70 mg/dl: Score 6
18.
Hemoglobin
Men
Hemoglobin 12 to 13 g/dl: Score 1
Hemoglobin 10 to 12 g/dl: Score 3
Hemoglobin <10 g/dl: Score 6
Women
Hemoglobin 10 to 12 g/dl: Score 1
Hemoglobin <10 g/dl: Score 6
21. Interpretation
Assesses probability for intervention
Endoscopy
Surgery
Score predicting resolution without intervention:
<4
Score predicting intervention: >5
22. MANAGEMENT
INITIAL:
Nasogastric Tube with aspirate
Fresh blood suggests persistant bleeding
Avoid lavage due to aspiration risk
If severe bleeding and suspected variceal source
See Esophageal Varices
Octreotide 50 ug bolus, then 50 ug/hour
23. Management: General Measures
Helicobacter Pylori management
Empiric acid reduction (Proton Pump Inhibitor)
Not proven in-vivo to aid clotting
No proven benefit in mortality and other
outcomes
Does not lower overall Incidence of re-bleeding
Omeprazole may heal ulcer if near-achlorhydria
24. Management: Low risk patients
Indications
Hemodynamically stable within 1 hour of
Resuscitation
Minimal Blood Products required (2 PRBC or
less)
No evidence of active bleeding
Nasogastric Tube aspirate without blood
No active comorbid medical conditions
25.
Protocol
Consider for rapid protocol
Immediate
Upper Endoscopy Evaluation of GI Bleeding
Discharge to home if low-risk endoscopy results
Admit if rapid protocol not available
Follow moderate risk patient protocol below
General measures as above
26. Management: High risk patients
Indications
Active ongoing bleeding
Hypotension persists despite Resuscitation
Severe active comorbid condition exascerbation
Liver disease exascerbation
Endotracheal Intubation for airway protection
27.
Protocol
General measures as above
Admit to intensive care unit for first 24 hours
Observe in hospital for 48 to 72 hours or more
Urgent upper endoscopy when stabilized
See
Upper Endoscopy Evaluation of GI Bleeding
Consider arteriography if source not evident
28.
29. Outcomes
Overall Mortality: 2-15% (often related to
comorbidity)
Bleeding stops and does not recur: 70% (<2%
Mortality)
Bleeding after initially stopped: 25% (10%
Mortality)
Continued active bleed: 5% (30% Mortality)