Summary about GIT bleeding including Hx, examinations, ddx & Tx

1. 61 Bleeding
6,
Bleeding ↓ GIB =
Proximal to the ligament of Treitz, JE.g. Esophageal Variceal bleeding,
UGIB Typically manifests with Bleeding Peptic user (
(Hematemesis, Hematoclezia, Melenal
May occur if the Bleeding is Brisk
LGIB =
Distal to the
ligament
of
Freitz, (E.9, Diserticular bleeding
LGIB TYPically Manifests with Malignan 24
(Hematochezia, Melena May be occur sall bowel bleeding
if
Bleeding is from the small bowel
or
proximal colon.
*
UGI B 170-80%) of GI
Hemorrhages *
L6IB (20-30%) of
GI Hemorrhages
*
Source of Bleeding is proximal to the ligament * The source of the Bleeding IS Distal
of Treitz. to the ligament
of Treitz
usually in the colon.
-
.
.
B
·
is
a
hy
↑
Superior Mesenter iC
Artery
Aorta

2. Efis19Y:-
UGIB Erosiv or Inflammatory
*
Peptic uncer (-30%)
*
ES-PhagitiS
* Erosive Gastrixis And/or Duodenitis
-a scular
*
Esophageal variceS most common with liver cirrosis
o
gastric varices
And Portal Hypertension
x
Gastric Antral vascular Ectasia Pikionitesmall,bloodvesseas
*
Diculatory Lesion minutes
analysedin the one"scosa
*
Angio-DysPlagia CAU malformations
Tumors
x
Esophageal cancer Andfor Gastric carcinoma
↑
raumatic
*
Mallory -
Weiss syndrome
*
Hiatal Hernias
other causes
*
Portal Hypertensive gastro-pathy
*
coagulopathies
L6IB Erosiv or Inflammatory
*
Diverticulosis (30%)
*
I
B 1) :vicentaammatory
BowelDiseaseseet
-a scular
swollen veins in
*
Hemarvoids as and lower Rectum
*
ISCLemi a sneric isma
*
AU Mal-formation
*
Rectal Varices
Tumors
*
Colorectal cancer and /or Anal cancer
*
Colonic Polyps
↑
raumatic
* Lower Abdominal trauma
other causes
*
Anal fissures

3. *
Peptic ulcer
*
AU mal-formation
*
I
BD
*
Ischemia
*
Ansio-DYSPlas; a
I
Hintal Hernia
- Portal Hypertensive
Gas + ro - Pa +
2]
gastric can cinoma
*
in
a
-
gastric favices
crosive gastritis
⑳ ⑥
>
Colo-Rectal canc

4. Clinical features or
- Hemate mesiS pvomiting Blood"
Red or coffee-ground"l) ->
WGIB
-
Melena "Black, tarry
stools UGIB most
com. Small Bowel or RA. Colon
->
Hematochez,a Bright Red "fresh" Blood through Anus-
L6IB most
come, Rapid UGIB
-
Anemia
Mangment or
*
Stable Patients
-Ensure Patient is NP
. Nothing Take by mouth food or medication
-
Two IV Lines for fluid And Blood Transfusion Ab47-8 9/dL
-Blood Samples for Lab Studies CBC, TYPE And cross Match
-
Anti-coagulant INR) 2,5, consider IV PPI
- Endoscopy (EGD, colonosc., sigmoidoscopy) According to source of
Bleeding
-If we
consider evaluation
*
Unstable Patients /for small bowel bleeding
-
ABCDE Approach
ing citie
Air way Disability Exposure
Ex tube GCS
- Two IV lines
-
IV fluid Resuscitation And Blood Transfusion If
Need.
- Blood Sample Anti-coagulant INR72.5, consider IV PPI
-
T
arget
normal vital sighs (Temp., RR, PR and BPI Before
Diagnostic test
if
possible
Si
If we
consider evaluation
for small bowel bleeding
- Endoscopy (EGD, colonosc., sigmoidoscopy) According to source of
Bleeding
-
Refractory Hemodynamic sustability -
CTA, surgery.
Diagnosis
A
rxul+ 6IB
· fecal occult Blood test
(f0BT)
· CBC
· Non-urgent
Endoscopy
If fort
is positive
sable Patient:
*
U6IB 70-80 %.
I". GD
2 colonoSCOPY
. Evaluation for small bowell bleeding
*
L6IB 20 -
30%-
· Calo noS20PY
2461
"Vid es
3. Evaluation for small bowell bleeding -> CTA, IC
moscope
CaPSule"

5. Unstable Patient -
*
u6IB
· EGD
· Refractory Hemodynamic instability consider CTA or Surgery
*
26IB
·
coconoscopy show pretest
probability of
USABL
!
&
deally be
↑
performed within · Refractory Hemodynamic instability-> Angiography and source-control
24 of
Admissing
test
probability of
UGIB)-ave No Aspirate
-
Lab. Studies: Sir
· CBC: Ab>13, Acts.Platelet count 150-400
· Coagulation Palel (Prothrombin time, API, INR, Serum fibrinogen concentration And D-Dimer concentration).
·
BMP: ↑ BUN/Cr Ratio suggests a Brisk a UCIB.
·Blood type And Cross-Matching
· Liver chemistries: in suspected esoph. Variceal Hemorrhage.
Treatment.
A-Treatment of
61 Bleeding
radications
-ecn,sin
is
an
*
Endoscopy Hemostasis
I
· Adherent clot
*
Interventional Radiology "Angioraphy"(Angio -Embolizations
&
ndications. 65 Bleeding a Hemodynamic sustability Refractor]
to Resuscitation.
· Alternative to colonscopy in PA. With Acute (GIB
Who cannot
tolerate bowel preparation.
·
Rebleeding After Endoscopic Hemostasis
*
Surgery
Indications. If
other therapeutic options failed
· GS Bleeding a Hemodynamic sustability
B-Treatment of
the underlying cause
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2023
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