This document discusses signs and symptoms of gastrointestinal bleeding, including melena, haematemesis, and haematochezia. It covers evaluation, treatment, and management of variceal bleeding including pharmacologic therapies, endoscopic procedures like band ligation and sclerotherapy, and surgical options like shunts and transplantation.

3.  Melaena – the passage of black, tarry stools
indicates likely UGI bleed (proximal to the
ligament of Treitz)
 Haematemesis – vomitus containing frank blood
or brown-black “coffee grounds”
 Haematochezia – passage of bright or dark red
blood per rectum
In general, the redder the blood, the more
distal the site of bleeding

4.  Red: beets, laxatives, phenytoin, rifampin
 Black:
bismuth, activated
charcoal, iron, spinach, blueberry, licorice

12.  Drugs
 Retching or vomiting
 Jaundice
 Procedures
 Recurrent abdominal pain
 Bleeding disorders in family
 Odynophagia

13.  Stigmata of chronic liver disease
 General condition
 External vascular malformation
 Hyperpigmented lips
 Dilated abdominal wall veins, Splenomegaly

15.  Removes blood from stomach – facilitates
easier endoscopy
 Confirmation of bleed/ongoing blood loss
 Prevents development of encephalopathy in
cirrhotic patients

16.  Disproportionate tachycardia
 “Tilt” test
 Capillary refill time
 Signs of shock

20.  Portal vein agenesis, atresia, stenosis
 Portal vein thrombosis or cavernous
transformation
 Splenic vein thrombosis
 Arteriovenous fistula

22.  Acts by increasing splanchnic vascular tone
 0.3
units per kg per hour after a bolus of 0.3
U/kg over 20 min
 Theaddition of nitroglycerin (skin patch)
decreases the systemic .effects of
vasopressin
 Terlipressin-longer duration of action and
lesser cardiac side effects

23.  much better side-effect profile and similar
efficacy
3 to 5 μg per kg per hour
 Octreotide has a longer half-life- bolus (2
μg/kg) followed by continuous infusion (1 to
5 μg per kg per hour)

24.  antibioticprophylaxis directed at intestinal
flora (third-generation cephalosporin) should
be started from admission
 H2receptor blocker or proton pump inhibitor
intravenously

25.  Acts by producing intimitis
 Injected either intra- or paravariceal
 Intravariceal
cyanoacrylate or histacryl glue
and thrombin for gastric varices
 Complications of EST include
ulceration, pain, perforation, and
bacteremia.

26.  Draws a visible varix into the lumen of the
ligator and a band is placed around the varix
 EVLis just as effective as EST but was
associated with fewer complications and
faster obliteration of varices.

29.  Indications:
 Recurrent variceal hemorrhage
 Refractory ascites
 Hepatorenal syndrome
 Contraindications
 Polycystic liver disease
 Right heart failure
 Systemic infection
 Portal vein thrombosis
 Severe hepatic encephalopathy

30.  Primary prophylaxis - propranolol
 Secondary prophylaxis – EVL/EST
 Surgical treatment:
 Patients with EHPVO
 bleeding gastric or other nonesophageal
varices
 severe hypersplenism

31.  Decompressive shunts
 Devascularization
 Liver transplantation