Aetiology of upper gi bleed

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  • 1. UPPER GI BLEED

2. AETIOLOGY 3. PEPTIC ULCER Breaks in the mucosal surface >5 mm 2 types- Duodenal Ulcers Gastric Ulcers NSAIDS H.Pylori PEPTIC ULCER 4. GASTRIC EROSIONS GASTRITIS Alcohol intake NSAID use Stress 5. ESOPHAGITIS Inflammation of esophagealmucosaa) GERDb) Barret Esophagusc) Chemical Esophagitis-alcohol,acids,alkalisd) Infectious esophagitis-HSV,CMV,fungal 6. Mallory-Weiss tear Longitudinal tears Alcoholics Symptoms : Vomiting retching HEAMATEMESIS Coughing 7. ESOPHAGEAL VARICES Liver diseasesCirrhosis Portal Hypertension 8. NEOPLASMS Ca.esophagus-Squamous cell CaAdeno Ca Ca.stomach-Second most common Tumor 9. LESS COMMON CAUSES Vascular MalformationsHereditary hemorrhagic telangiectasias Aorto-duodenal Fistula Hemosuccus pancreaticusBleeding from the bile duct or pancreaticduct 10. CLINICALPRESENTATION 11. 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. 12. 4. Occult GI bleeding absence of overt bleedingfecal occult blood test - +ve presence of iron deficiency.5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea. 13. I. HAEMATEMESIS vomiting of blood follows bleedingfrom esophagus ,stomach andduodenum( above the duodenalflexure)COMMON CAUSESi.Ruptured oesophageal varicesii. Esophageal carcinomaiii. Chronic gastric ulcer 14. iv. Carcinoma stomachv. chronic duodenal ulcervi. Mallory Weiss syndromeLESS COMMON CAUSES blood dyscrasias Lymphoma of stomach Anticoagulant therapy Uraemia 15. If the source of bleeding is abovegastro-oesophageal sphincter ( eg :oesophageal varices) fresh bloodwells up in mouth than beingactively vomited 16. Mallory Weiss tear-patient vomits several timesfresh blood only appearsafter the initial vomit 17. Sudden loss of > 20% -tachycardia, hypotension, faintness andsweating Brisk hematemesis -from largevessel in an ulcerBRIGHT RED Bright red blood naso or oropharynx 18. Slower upper GI bleeding-mixing of blood with gastricjuicedarker, like that of ground coffee 19. II. MELAENA - black , tarry stools containingoccult blood -Upper GI bleeding -Haemorrhage from right side ofcolon -appx 60 ml of blood - singleblack coloured stool 20. Blood for 14 hrs in the GI tract Characteristicsi. Black tarry stool- due to production of acid haematinii. Offensive odour - acid haematin is altered by bacteriaiii. Semisolid in consistencyiv. Usually associated with vertigo , dizziness, syncopal attack during defecation 21. Causes all the causes ofhaematemesis may producemelaena Rarely, swallowed blood giverise to melaena: epistaxis 22. Thank you...