1. Upper gastrointestinal bleeding is defined as bleeding from a source proximal to the ligament of Treitz and is 4 times more common than lower GI bleeding, occurring more frequently in males. 2. Upper GI bleeding can be variceal, from complications of liver disease, or non-variceal, associated with peptic ulcer disease. Common clinical features include abdominal pain, vomiting blood, black tarry stools, and signs of blood loss. 3. Initial management involves airway protection, IV access, fluid resuscitation, and blood transfusions. Endoscopy allows for diagnosis and treatment with clips, cautery, or injections while angiography with embolization is used for uncontrolled arterial bleeding.

1. DR. SHAKIB MASU SIR
SURGICAL UNIT 4 (HOU)

2. DEFINATION
 UPPER GASTROINTESTINAL BLEED IS DEFINED AS
BLEEDING DERIVED FROM SOURCE PROXIMAL
TO LIGAMENT OF TREITZ.
 UGIB IS 4 TIMES AS COMMOM AS LOWER GI
BLEED , WITH HIGHER INCIDENCE IN MALES.

3. TYPES
 VAREICEAL – AS A
COMPLICATION OF
END STAGE DISEASE.
 NON VARIECEAL –
ASSOCIATED WITH
PEPTIC ULCER
DISEASE AND
RELATED ETIOLOGY

4. ETIOLOGY

5. CLINICAL FEATURES
 ABDOMINAL PAIN
 HEMATEMESIS
 HEMATOCHEZIA
 MALAENA
 FEATURES OF BLOOD LOSS - SHOCK,SYNCOPE,
ANEMIA
 FEATURES OF UNDERLYING CAUZE – DYSPEPSIA,
JAUNDICE, WEIGHTLOSS

6. PRESENTATIONS
 1. HEMATEMESIS : VOMITING OF BLOOD
 CAN BE COFFEE GROUND (SLOWER RATE OF
BLEEDING) OR GROSS FRANK BLOOD INDICATING
RAPID BLEED
 2. MALENA – PARTIALLY DIGESTED BLOOD (
BALCK,TARRY,SEMISOLID HAS DISTINCTIVE ODOUR)
INDICATES BLOOD IN GIT FOR >14 HRS . THE
PROXIMAL THE BLEEDING SITE , MORE THE MALENA
 3.HEMATOCHEZIA – FRANK BLOOD IN STOOL
USUALLY IN LOWER GI BLEED , INDICATES RAPID GI
BLEED

7. SIGNS AND SYMPTOMS
 SYNCOPE
 DYSPEPSIA
 EPIGASTRIC PAIN
 HEARTBURN
 DYSPHAGIA
 JAUNDICE
 WIEGHTLOSS

8. INVESTIGATIONS
BLOOD INVESTIGATIONS
 CBC FOR HEMAGLOBIN COUNT AND
HEMATOCRIT
 RTF AND LFT FOR UNDERLYING RENAL OR LIVER
DISEASE
 S.CALCIUM LEVEL FOR UNDERLYING
HYPERPARATHYROIDISM
 GASTRIN LEVEL
 BUN RATIO
 PT,APTT ,INR FOR BLEEDING DISORDERS

9. UPPER GI ENDOSCOPY
AN UPPER GI ENDOSCOPY ALSO
KNOWN AS
ESOPHAGOGASTRODUODENOSCOPY
IS A DIAGNOSTIC AND THERAPEUTIC
PROCEDURE
AN ENDOSCOPE (FLEXIBLE / RIGID)
CONSISTING OF CAMERA AND LIGHT
SOURCE IS PASSED THROUGH
NATURAL ORIFICES I.E. MOUTH TO
VISUALIZE UPPER GI TRACT

10. RADIOLOGICAL INVESTIGATION
 CHEST XRAY TO EXCLUDE ASPIRATION
PNEUMONIA, EFFUSION, OESOPHAGEAL
PERFORATION
 ABDOMINAL XRAY –FOR PERFORATED VISCUS
AND ILEUS
 USG AND CT SCAN FOR CIRRHOSIS,
CHOLECYSTITS WITH HEMORRHAGE,
PANCREATITIS WITH HEMORHHAGE,
AORTOENTERIC FISTULA.

11. ANGIOGRAPHY
 ANGIOGRAPHY MAY BE USEFUL IN BLEEDIND
PERSISTS AND ENDOSCOPY FAILS TO IDENTIFY A
BLEEDING SITE
 ANGIOGRAPHY ALONG WITH TRANSCATHETER
ARTERIAL EMBOLISATION (TAE) SHOULD BE
CONSIDERED FOR ALL PATIENTS WITH A KNOWN
SOURCE OF ARTERIAL UGI BLEEDING THAT DOES
NOT RESPOND TO ENDOSCOPIC MANAGEMENT

13. SEVERITY
SCORE >= 8 IS FATAL
SCORE<=3 IS SUGGESTIVE OF GOOD PROGNOSIS

14. MANAGEMENT
 INITIAL MANAGEMENT AND RESUSCITATION
 PROTECT AIRWAY : PLACE PATIENT IN LEFT
LATERAL POSITION
 IV AACCESS AND BLOOD INVESTIGATIONS
 RESTORE CIRCULATION IN FORM OF FLUIDS (
CRYSTALLOIDS AND COLLOIDS)
 BLOOD TRANSFUSION IN FORM OF WHOLE
BLOOD OR PLATELET IN MASSIVE LOSS ,
HEMATOCRIT <25%, ACTIVE BLEEDING.

15. TREATMENT OF VAREICEAL BLEED
 VASOPRESSIN
ANALOGUES LIKE
TERLIPRESSIN AND
OCTREOTIDE
 PRPHYLACTIC
ANTIBIOTICS
 BALLOON
TAMPONADE FOR
UNCONTROLLED
BLEEDING

16. TREATMENT OF VAREICEAL BLEED
1 . OESOPHAGEAL VARIECES
 BAND LIGATION
 STENT INSERTION
 TIPS – TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNTS
2. GASTRIC VAREICES
 ENDOSCOPIC INJECTION OF N BUTYL 2-
CYANOACRYLATE
 TIPS

17. ENDOSCOPIC BAND LIGATION

18. TIPS

19. TREATMENT OF NON VAREICEAL
BLEED
 ENDOSCOPY THERAPY IS THE TREATTMENT FOR
CONTROLLING ACTIVE PEPTIC ULCER DISEASE
 BLACK/ RED SPOTTED CLEAN ULCER BASE HAVE
EXCELLENT PROGNOSIS
 ONE OF THE FOLLOWING SHOULD BE USED
 1.MECHANICAL CLIPS WITH OR WITHOUT
ADRENALINE
 2. THERMAL COAGULATION
 3. FIBRIN OR THROMIN

21. INDICATIONS FOR SURGERY
 FAILURE OF MEDICAL MANAGEMENT
 COEXISTING PERFORATION, OBSTRUCTION OR
MALIGNANCY
 REPEATED TRANSFUSIONS
 RECURRENT HOSPITALISATIONS

22. TYPES OF SURGERY
 IT DEPENDS UPON SITE OF LEISONS
 DUODENAL AND GASTRIC ULCERS ARE TREATED
WITH PYLOROPLASTY

23. PREVENTION
 THE MOST IMPORTANT FACTOR TO CONSIDER IS
TREATMENT FOR H.PYLORI INFECTION
 1ST LINE THERAPY :
 PPI( OMPRAZOLE,PANTOPRAZOLE ETC )
 AND TWO OF THESE (CLARITHROMYCIN,
AMOXYCILLIN,METRONIDAZOLE)
 2ND LINE THERAPY :
 PPI
 BISMUTH
 METRONIDAZOLE
 TETRECYCLINES
 FOR 7 DAYS

24. THANK YOU