UPPER GI BLEED

AETIOLOGY

PEPTIC ULCER

• Breaks in the mucosal surface >5 mm

• 2 types-• Duodenal Ulcers • Gastric Ulcers

• NSAIDS H.Pylori

PEPTIC ULCER

GASTRIC EROSIONS

• GASTRITIS• Alcohol intake• NSAID use• Stress

ESOPHAGITIS

• Inflammation of esophageal mucosa

a) GERD

b) Barret Esophagus

c) Chemical Esophagitis-alcohol,acids,alkalis

d) Infectious esophagitis- HSV,CMV,fungal

Mallory-Weiss tear• Longitudinal tears

• Alcoholics

• Symptoms :• Vomiting• retching • Coughing

HEAMATEMESIS

ESOPHAGEAL VARICES

• Liver diseases– Cirrhosis

• Portal Hypertension

NEOPLASMS

• Ca.esophagus-

Squamous cell Ca

Adeno Ca

• Ca.stomach-Second most common Tumor

LESS COMMON CAUSES

• Vascular Malformations

Hereditary hemorrhagic telangiectasias

• Aorto-duodenal Fistula

• Hemosuccus pancreaticus

Bleeding from the bile duct or pancreatic duct

CLINICAL PRESENTATION

Bleeding - present in 5 ways.

1. Hematemesis - red blood or "coffee-ground" material.

2. Melena - black, tarry, foul-smelling stool.

3. Hematochezia - passage of bright red or maroon blood from the rectum.

4. Occult GI bleeding –

absence of overt bleeding

fecal occult blood test - +ve

presence of iron deficiency.

5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea.

I. HAEMATEMESIS

• vomiting of blood follows bleeding from esophagus ,stomach and duodenum( above the duodenal flexure)

COMMON CAUSES

i. Ruptured oesophageal varices

ii. Esophageal carcinoma

iii. Chronic gastric ulcer

iv. Carcinoma stomach

v. chronic duodenal ulcer

vi. Mallory Weiss syndrome

LESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia

• If the source of bleeding is above gastro-oesophageal sphincter ( eg : oesophageal varices) fresh blood wells up in mouth than being actively vomited

Mallory – Weiss tear-

patient vomits several times

fresh blood only appears after the initial vomit

• Sudden loss of > 20%

-tachycardia , hypotension, faintness and sweating

• Brisk hematemesis -from large vessel in an ulcer BRIGHT RED

• Bright red blood –naso or oro pharynx

• Slower upper GI bleeding- mixing of blood with gastric juice

darker, like that of ground coffee

II. MELAENA

- black , tarry stools containing occult blood

-Upper GI bleeding -Haemorrhage from right side of

colon -appx 60 ml of blood - single

black coloured stool

Blood for 14 hrs in the GI tract• Characteristics

i. Black tarry stool- due to production of acid haematin

ii. Offensive odour - acid haematin is altered by bacteria

iii. Semisolid in consistency

iv. Usually associated with vertigo , dizziness, syncopal attack during defecation

• Causes – all the causes of haematemesis may produce melaena

• Rarely, swallowed blood give rise to melaena: epistaxis

Thank you...