Management of upper gi bleed

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  • 1. I/V access with large bore cannula Basic investigations-blood count,routine biochemistry,cross match blood Hourly measurements of Bp,pulse and urine output.. i/v colloids or crystalloids pt with hypotension and tachycarda Transfuse with blood Endoscopy for diagnosis & Rx Iv PPI therapy for bleeding peptic ulcer
  • 2. 0.9 % saline Vasopressor(terlipressin) Prophylactic antibiotics Emegency endoscope Variceal band ligation Proton pump inhibitor Phosp[hate enema/lactulose enema
  • 3. ENDOSCOPIC THERAPY with * Bipolar electro coagulation * Heater probe * Injection therapy - Absolute alcohol - 1:10000 epinephrine - Clips High dose constant infusion of iv PPI E.g. Omeprazole 80 mg bolus & 8 mg/hr infusion
  • 4. Eradication of H.Pylori infection Discontinue NSAIDS & acids If NSAIDS have to be used, use along with PPI Use selective COX-2 inhibitors like Coxib or traditional NSAIDS + Coxib Coxib + PPI : further significant decrease in ulcers and recurrent bleeding.
  • 5. Mostly bleeding stops spontaneously ( Recurrence is only 0-7 % ) Endoscopic therapy is only for actively bleeding Mallory weiss tear. Angiographic therapy with embolization & operative therapy with over sewing of tear can be done ( but only required rarely )
  • 6. I. Vasoconstrictors (somatostatin, octreotide, terlipressin) iv terlipressin infusion at 2 mg 6th hourly, generalized vasoconstriction leading to decreased blood flow to venous system.II. Baloon tamponade Triple lumen or Four lumen tube with esophageal and gastric balloons. (Always intubate the patient prior to this procedure to prevent aspiration)III. Endoscopic variceal liagation[Band ligation]IV. SclerotherapyV. Antibiotic therapy
  • 7. Quinolones for patients with cirrhosis decreases the bacterial infection & mortality. Non selective Beta blockers Propranalol, Nadolol For recurrent esophageal bleeding c/c therapy with beta blocker + endoscopic ligation If not subsided with medical therapy, Go for:
  • 8. INVASIVE THERAPY: TIPss (Transjugular intrahepatic portosystemic shunt) A/E : Hep encephalopathy, shunt stenosis in 1 yr Vascular ectasias are treated by endoscopic therapy Estrogen / progesterone components are used in vascular ectasias
  • 9. avoiding the long-term use of alcohol, NSAIDs, coffee, high- fat foods and drugs Reducing stress through relaxation techniques Antacids, H2 blockers, PPIs Triple therapy: 2 antibiotics + a PPI is commonly used to treat H. Pylori related gastritis
  • 10. Thank you.