History taking upper gastro intestinal bleeding
-
Upload
abino-david -
Category
Health & Medicine
-
view
6.731 -
download
0
Transcript of History taking upper gastro intestinal bleeding
![Page 1: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/1.jpg)
CLINICAL APPROACH TO PATIENT WITH UPPER GASTROINTESTINAL
BLEEDING
![Page 2: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/2.jpg)
Features Upper GI bleed
Lower GI bleed
Site Above Ligament of Treitz
Below Ligament of Treitz
Presentation Hemetemesis or Malena
Hematochezia
Nasogastric aspiration
Blood Clear fluid
Bowel sounds
Hyperactive Normal
BUN/ Creatinine ratio
Increased Normal
![Page 3: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/3.jpg)
HISTORY
![Page 4: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/4.jpg)
Presenting Complaints
HematemesisMalenaHematocheziaSymptoms of blood loss-
lightheadedness, syncope, dysnea (Occult blood in stools)
![Page 5: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/5.jpg)
MODE OF ENQUIRY
Onset ,episodesTrue or spuriousBleeding from oral
cavity/nasopharynxH/O retching with non bloody
vomitus followed by hemetemesisH/O anorexia,dysphagia, rapid
weight loss
![Page 6: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/6.jpg)
H/O malenaH/O drug intake NSAIDs, aspirin or
anti coagulantsH/O alcohol intakeAny skin telangiectasias? Any pigmentation? Perioral Diffuse
![Page 7: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/7.jpg)
PAST HISTORY
H/O Chronic Liver DiseaseH/O Peptic ulcer H/O Bleeding disordersComorbidities -Pre existing
CVS/Renal/CNS d/s may be worsened by a/c bleeding
H/O medical illness/surgical intervention
FAMILY HISTORY -hemetemesis
![Page 8: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/8.jpg)
CLINICAL EXAMINATION
![Page 9: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/9.jpg)
General Examination
Built and NourishmentPallor(chronic bleeding)Icterus(CLD)CyanosisClubbingLymphadenopathy(CA stomach)Edema
![Page 10: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/10.jpg)
Vitals
PulseBPHEMODYNAMIC INSTABILITY-
Hypotension, Tachycardia, Postural changes in BP and heart rate
Respiratory RateTemperature
![Page 11: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/11.jpg)
Assessment of Blood Loss
BLOOD LOSS CLINICAL FEATURES
500ml No systemic signs except in elderly and anaemic patients
1000ml(20% reduction in blood volume)
Tachycardia, Orthostatic hypotension, syncope, light headedness, nausea, sweating, thirst
2000ml(40% reduction in blood volume)
Profound shock and possibly death
![Page 12: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/12.jpg)
Also Look For
Any source of bleeding from oral cavity
Telengiectasias in skin, conjunctiva,oral cavity
Perioral/diffuse pigmentationParaneoplastic syndromes
STIGMATA OF CLD
![Page 13: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/13.jpg)
Perioral pigmentation
![Page 14: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/14.jpg)
Skin telengiectasias
![Page 15: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/15.jpg)
Telengiectasia in Eye
![Page 16: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/16.jpg)
STIGMATA OF CLD
![Page 17: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/17.jpg)
Skin, nails and Hands
Spider naevi - small telangiectatic superficial blood vessels with a central feeding vessel
ClubbingLeukonychia - expansion of the paler half-moon at
the base of the nailPalmar erythema - seen on the thenar and
hypothenar eminences, often with a blotchy appearance
BruisingDupuytren's contracture - can occur in the absence
of liver diseaseScratch marks - particularly in cholestatic liver
diseaseFlapping Tremor
![Page 18: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/18.jpg)
Endocrine - due to excess oestrogens
GynaecomastiaTesticular atrophyLoss of axillary and pubic hairTelengiectasias
Others
Hepatic fetor - characteristic sweet-smelling breath
Parotid swelling - particularly in alcohol-related liver disease
![Page 19: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/19.jpg)
Dupuytren’s contracture
Spider naevi
![Page 20: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/20.jpg)
![Page 21: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/21.jpg)
Examination of Abdomen
Any mass lesionHepatosplenomegalyHyperactive bowel sounds
Examination of Lymph nodes
![Page 22: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/22.jpg)
Rockall Score for Risk Stratification in A/C Upper GI Bleeds
Predicts SeverityFinal score 0-11Score<3 good prognosis
Score>6 indication for Surgery
Score>8 high risk of mortality
![Page 23: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/23.jpg)
SCORE 0 1 2 31.Age <60 60-79 >80
2.Shock No shock Pulse>100
SBP<100
3.Comorbidity
No Major CCF, IHD, Major
Renal/Liver Failure
Metastatic cancer
4.Diagnosis after Endoscopy
Mallory Weiss tear or normal
All other diagnosis
GI malignancy
5.Endoscopic Evidence of Bleeding
None Blood in Stomach
Adherent clot, Visible or spurting vessel
![Page 24: History taking upper gastro intestinal bleeding](https://reader035.fdocuments.net/reader035/viewer/2022062513/556e5f13d8b42a6a248b48f3/html5/thumbnails/24.jpg)
THANK YOU
THANK YOU