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    Upper Gi Bleeding

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    nawriirwan
    This document discusses upper gastrointestinal bleeding (UGIB). It describes the clinical manifestations of acute and chronic UGIB. The common causes of nonvariceal UGIB are then listed, including peptic ulcer disease, gastritis, and esophageal tears. Risk factors for UGIB and the physical exam findings are also outlined. The priorities in management are resuscitation of the patient and initial evaluation of the severity of bleeding and comorbidities. Endoscopic and drug therapies are described for treating nonvariceal bleeding sources. Variceal bleeding due to portal hypertension is also discussed.

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    Upper Gi Bleeding

    Uploaded by

    nawriirwan
    173 views35 pages
    This document discusses upper gastrointestinal bleeding (UGIB). It describes the clinical manifestations of acute and chronic UGIB. The common causes of nonvariceal UGIB are then listed, including peptic ulcer disease, gastritis, and esophageal tears. Risk factors for UGIB and the physical exam findings are also outlined. The priorities in management are resuscitation of the patient and initial evaluation of the severity of bleeding and comorbidities. Endoscopic and drug therapies are described for treating nonvariceal bleeding sources. Variceal bleeding due to portal hypertension is also discussed.

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    Upper Gi Bleeding

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    This document discusses upper gastrointestinal bleeding (UGIB). It describes the clinical manifestations of acute and chronic UGIB. The common causes of nonvariceal UGIB are then listed, including peptic ulcer disease, gastritis, and esophageal tears. Risk factors for UGIB and the physical exam findings are also outlined. The priorities in management are resuscitation of the patient and initial evaluation of the severity of bleeding and comorbidities. Endoscopic and drug therapies are described for treating nonvariceal bleeding sources. Variceal bleeding due to portal hypertension is also discussed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    173 views35 pages

    Upper Gi Bleeding

    Uploaded by

    nawriirwan
    This document discusses upper gastrointestinal bleeding (UGIB). It describes the clinical manifestations of acute and chronic UGIB. The common causes of nonvariceal UGIB are then listed, including peptic ulcer disease, gastritis, and esophageal tears. Risk factors for UGIB and the physical exam findings are also outlined. The priorities in management are resuscitation of the patient and initial evaluation of the severity of bleeding and comorbidities. Endoscopic and drug therapies are described for treating nonvariceal bleeding sources. Variceal bleeding due to portal hypertension is also discussed.

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    UPPER

    GASTROINTESTINAL
    BLEEDING

    Clinical manifestation

    ACUTE BLEEDING
    Hemet emesis
    Coffee ground emesis
    Melena
    Hematocesia
    Occult bleeding
    Obscure bleeding
    Hypovolemic Shock
    CHRONIC BLEEDING
    Anemia

    Caused Upper UGI Bleeding


    nonvariceal

    Gastric antral vascular ectasia


    Peptic ulcer disease (50%)
    Haemorrhagic gastritis/duodenitis
    Oesophagitis
    Mallory weiss tear
    Cameron ulcer
    Dieulafoy lesion
    Corrosive ingestion
    Haemobilia
    Malignancy

    Predisposing Factors
    Age
    Alcohol Use
    Aspirin Ingestion/Other Drugs
    Hormones
    Hyperacidity
    Infectious
    Inheritance
    Stress

    PHYSICAL EXAMINATION
    Orthostatic

    changes in pulse & BP


    Cardiopulmonary
    Skin
    Examine oral cavity & nasopharynx
    Lymph nodes
    Abdomen
    Rectal Examination

    First priority
    Resuscitation
    A_B_C procedure
    Gastric lavage +cooling
    Initial evaluation

    Major bleeding

    Minor Bleeding

    Resuscitation
    Volume replacement
    crystaloid, coloid, blood tranfusion
    Comorbidity evaluation
    Cardiac failure
    Respiratory Ds
    Renal Ds
    Liver cirrhosis

    Initial evaluation
    Clinical

    severity of bleeding
    Blood sample :

    FBC,Urea,creatinine,

    Electrolyte,cloting profil,

    Blood group & cross match

    Severity bleeding : clinical


    criteria

    Severity bleeding

    criteria

    Mild

    < 1g/dl drop Hb


    Minimal/ no anemia
    Stable hemodynamic
    Infrequent melena
    Coffee hemet emesis

    Moderate

    1-2 g/dl drop Hb


    Hb : 10 g/dl
    Tachycardia
    Melena
    Hemet emesis

    Severe

    g/dl drop Hb
    Hb < 10 g/dl
    Orthostatism/shock
    Hematochesia > 350 cc
    Repeated hemet emesis

    Predictors UGIB

    Acute U.G.I. Bleeding


    General

    Investigations:

    1.Hb, PCV
    2.CBC (WBC etc)
    3.Bld glucose
    4.Platelets, coagulation
    5.Urea, creatinine, electrolytes
    6.Liver biochem.
    7.Acid-base state
    8. Imaging: chest & abd. radiography, US, CT

    A. Endoscopic therapy
    Injection

    Thermal

    Other

    : adrenaline
    a lcoho l
    s clero sa nts
    thrombin
    : hea ter pro be
    electro co agula tio n
    a rgon beamer
    neo dymium YAG la ser
    : micro wa ve co agula tio n
    cyano acryla te glue

    B. Mechanical closure by endoclips


    C. Drug therapy for peptic ulcer bleeding
    PPI iv follow infusion 72 h
    or
    PPI daily iv
    or
    PPI oral
    Following with healing dose 8 weeks
    H pylori eradication
    re-scope 2-3 mo

    Mallory-Weiss
    Tear

    of mucosa around
    esophagogastric junction, after
    retching vomiting
    Bleeding occurs when involves
    plexus venous or arterial
    Usually in middle age
    Prompt endoscopies diagnostic
    procedure : longitudinal ulcer

    Mallory Weiss tear

    Differential Diagnosis
    Reflux

    esophagitis/ GERD
    Infectious esophagitis
    Usually, focal lesion with normal
    adjacent
    Contrast with other cause
    Barium x-ray : nondiagnostic

    Treatment

    :
    usually stop bleeding spontaneous
    endoscopic treatment
    H2 blocker, PPI accelerate healing

    Investigation Of Obscure bleeding


    Push

    enteroscopy
    Intraoperative enteroscopy
    Hemostatic during enteroscopy
    Capsul endoscopy
    Mesenteric angiography
    Radioisotope bleeding scans
    Exploratory laparotomy

    VARICEAL BLEEDING

    Natural history varices


    esophagus

    Pathogenesis varices
    rupture
    Explosion theory

    Increased portal
    pressure
    Increased variceal size
    Increase variceal wall
    tension

    Erosion theory

    Esophagitis
    Ulcerasion
    Deglutory trauma
    NSAIDs

    Warsning liver
    function

    Meals(postprandial
    hyperemia)
    Physical
    exercise

    Alcohol
    intake

    Portal
    Hypertension
    Formation of
    Varices

    Decr variceal wall


    thickness

    Incr Varices
    Size

    Incr Variceal
    Pressure

    Incr. Variceal Wall Tension

    VARICEAL

    Variceal hemorrhage

    Variceal Bleeding
    (Esophageal Gastric)

    INDICATIONS FOR
    ADMISSION & REFERRAL

    Admit pts with h/o recent brisk bleeding &


    orthostatic changes
    Admit pts with less severe blood loss who
    have co-morbid conditions aggravated by
    anemia
    Profound anemia with no evidence of blood
    loss
    Refer pts who are candidate for endoscopy
    or colonoscopy when source of bleeding is
    elusive

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