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    Upper Gi Bleeding

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    Anggreini Susanti
    The document discusses upper gastrointestinal bleeding, including clinical manifestations, causes, risk factors, evaluation, and management. It covers topics such as resuscitation of patients with acute bleeding, endoscopic therapies for bleeding lesions, and treatment of variceal bleeding. Predictors of rebleeding and differential diagnoses are also reviewed.

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    Upper Gi Bleeding

    Uploaded by

    Anggreini Susanti
    1K views35 pages
    The document discusses upper gastrointestinal bleeding, including clinical manifestations, causes, risk factors, evaluation, and management. It covers topics such as resuscitation of patients with acute bleeding, endoscopic therapies for bleeding lesions, and treatment of variceal bleeding. Predictors of rebleeding and differential diagnoses are also reviewed.

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    UPPER GI BLEEDING.ppt

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    The document discusses upper gastrointestinal bleeding, including clinical manifestations, causes, risk factors, evaluation, and management. It covers topics such as resuscitation of patients with acute bleeding, endoscopic therapies for bleeding lesions, and treatment of variceal bleeding. Predictors of rebleeding and differential diagnoses are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    1K views35 pages

    Upper Gi Bleeding

    Uploaded by

    Anggreini Susanti
    The document discusses upper gastrointestinal bleeding, including clinical manifestations, causes, risk factors, evaluation, and management. It covers topics such as resuscitation of patients with acute bleeding, endoscopic therapies for bleeding lesions, and treatment of variceal bleeding. Predictors of rebleeding and differential diagnoses are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 35

    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 2 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 : adrenaline
    alcohol
    sclerosants
    thrombin
    Thermal : heater probe
    electrocoagulation
    argon beamer
    neodymium YAG laser
    Other : microwave coagulation
    cyanoacrylate 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 Erosion theory

     Increased portal pressure  Esophagitis


     Increased variceal size  Ulcerasion
     Increase variceal wall  “Deglutory” trauma
    tension  NSAIDs
    Warsning liver function Meals(postprandial hyperemia)

    Alcohol intake Physical exercise

    Portal Hypertension
    Formation of Varices

    Decr variceal wall Incr Varices Size Incr Variceal Pressure


    thickness

    Incr. Variceal Wall Tension

    VARICEAL RUPTURE
    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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