Gastrintestinal Bleeding
-
Upload
dr-shatdal-chaudhary -
Category
Documents
-
view
222 -
download
0
Transcript of Gastrintestinal Bleeding
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 1/36
Upper and Lower Gastrointestinal
Bleeding
Dr. Shatdal Chaudhary MDAssistant Professor
Department of Internal Medicine, BPKIHS, Dharan
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 2/36
G I Bleeding
• Acute Vs Chronic
• Upper Vs Lower • Bleeding above/below the ligament of Treitz
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 3/36
Acute U G I Bleeding
Introduction• Most common gastrointestinal emergency
• Accounting for 50-120 admissions to hospitalper 100 000 of the population each year inthe U K.
• Higher among males, elderly
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 4/36
Causes of Upper GI Bleed (UGIB)
• Peptic Ulcer Disease (60% cases of UGIB)• Erosive Gastritis(10-20%)• Esophagitis (10%)•
Esophageal and Gastric Varices (2-9%)• Mallory-Weiss Syndrome(5%)• Malignancy(2%)
• Others – Stress ulcer, arteriovenous malformation, Aorto-
duodenal Fistula, corrosive poisoning
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 11/36
Clinical Features:
• History: Often misleading – Usually presents with obvious complaints (melaena,
hematemesis, etc.) or may present with more subtle signs(hypotension, tachycardia, etc)
•Hematemesis• Melaena
• Hematochezia• H/o NSAIDs, Alcohol abuse, corrosive intake• Weight loss/change in bowel habit (malignancy)• Vomiting/retching followed by hematemesis (Mallory-
Weiss)
• Hx aortic graft (possible aortocentric fistula)
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 16/36
• Angiography: sometimes can localize, but requiresbrisk bleeding rate (0.5 to 2.0 ml/min)
• Technetium-labeled red cell scan: more sensitive thanangiography
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 17/36
Treatment
• Primary – ABCs – Oxygen This should be given by facemask to all
patients in shock.
– Close monitoring
– Immediate resuscitation, 2 wide bore IV cannula
– NG tube in all patients with significant bleeding
– Consider blood transfusion if no improvementafter 2L of crystalloid or Hb < 10 gm/dL
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 20/36
Surgery – – if all other interventions are ineffective
– endoscopic haemostasis fails to stop activebleeding – rebleeding occurs on one occasion in an elderly
or frail patient, or twice in younger, fit patients
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 23/36
Lower GI Bleeding• Bleeding below the ligament of Treitz• This may be due to haemorrhage from the
– small bowel – colon or – anal canal
• Incidence: 20 per 100,000 population
CAUSES OF LOWER GI BLEEDING
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 24/36
CAUSES OF LOWER GI BLEEDING• Severe acute
– Diverticular disease
– Angiodysplasia – Ischaemia – Meckel's diverticulum
• Moderate, chronic/subacute
– Anal disease, e.g. fissure, haemorrhoids – Inflammatory bowel disease – Carcinoma – Large polyps
– Angiodysplasia – Radiation enteritis – Solitary rectal ulcer
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 25/36
ETIOLOGYDifferential Diagnosis of Lower Gastrointestinal Hemorrhage
COLONIC BLEEDING (95%) % SMALL BOWEL BLEEDING (5%)Diverticular disease 30-40 Angiodysplasias
Ischemia 5-10 Erosions or ulcers (potassium, NSAIDs)
Anorectal disease 5-15 Crohn's disease
Neoplasia 5-10 RadiationInfectious colitis 3-8 Meckel's diverticulum
Postpolypectomy 3-7 Neoplasia
Inflammatory bowel disease 3-4 Aortoenteric fistula
Angiodysplasia 3
Radiation colitis/proctitis 1-3
Other 1-5
Unknown 10-25
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 27/36
Options to diagnose and control the bleeding
• Colonoscopy• technetium-99m labeled RBC scan: requires 0.5-1
ml/min bleeding• Mesenteric angiography: requires 1-1.5 ml/min bleeding• Meckels scan• Capsule Endoscopy• Surgery
• faecal occult blood (FOB)
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 28/36
• Colonscopy: diagnostic and therapeutic• colonoscopy is necessary to exclude coexisting colorectal
cancer.
– subjects who also have altered bowel habit – and in all patients presenting at over 40 years of age,
8/14/2019 Gastrintestinal Bleeding
http://slidepdf.com/reader/full/gastrintestinal-bleeding 35/36
The End