Upper Gastro Intestinal Bleeding 632

8/13/2019 Upper Gastro Intestinal Bleeding 632

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UPPER GASTROINTESTINAL

HEMORRHAGE

Prof. Feroze Quader

Dept. of Surgery

BKZMC


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Upper GIT Hemorrhage is a very frequent medical problem.

Bleeding Peptic ulcer, Portal hypertension, Gastritis and

Oesophageal varices are the common causes for hemorrhage.

Hematemesis or melena is usually present unless rate of

bleeding is minimum.

Acute bleeding stops spontaneously is 75 % cases.

Rest of the patient requires surgery or die out of complications.


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Incidence %

Common causes

Peptic Ulcer 45

Dudenal ulcer

Gastric ulcer

Esophageal varices 20

Gastritis 20

Mallory-Weiss syndrome 10

Uncommon causes 5

Gastric Carcinoma

Esophagitis

Pancreatitis

Hemobilia

Duodenal diverticulum

Peptic Ulcer45%

Esophageal

varices

20%

Gastritis

20%

Mallory-

Weiss

syndrome

10%

Uncommoncauses

5%


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Gastric Ulcer Duodenal Ulcer Ca-Stomach


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Esophageal varices Gastritis


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Mallory-Weiss Tear


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Hematemesis

Vomiting of blood is common when bleeding originates fromStomach or esophagus. Color of the vomitus will be

coffee- ground when gastric acid converts hemoglobin into

methemoglobin.

Melena

Passage of black tarry stools are common when there is

bleeding from any part of Upper GIT.

The black color of melenic stools is caused by Hematin ,the

product of oxidation of Haemby intestinal and bacterial

enzymes.


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Hematochezia

It is defined as passage of bright-red blood from the ractum.

Common in bleeding from Colon, Rectum and Anus. In case of brisk bleeding in the Upper GIT, Bright red blood

may come out unchanged in the stool.


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Initial assessment and management goals:

Assessment of the status of the circulatory system and

replace blood loss as necessary.

Determine the amount and rate of bleeding.

Slow or stop the bleeding by ice-water lavage

Discover the lesion responsible for the episodes.

Specific management for underlying causes.


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Patient may have h/o weakness, dizziness, syncope associated

with Hematemesis, melena and hematochezia.

Patients may have a history of previous dyspepsia, ulcerdisease, early satiety, and NSAIDs use.

Smoking and alcohol may have some association.


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The goal of the patient's physical examination is to evaluate

for shock and blood loss.

signs of shock include cool extremities, oliguria, chest pain,pre-syncope, confusion, and delirium.

Hematemesis and melena should be noted.


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Signs of chronic liver disease should be noted, including

spider angiomata,

gynecomastia,

splenomegaly,

ascites,

pedal edema

Signs of tumor are uncommon but indicate a poor prognosis.

Signs include a nodular liver, abdominal mass, and enlarged

and firm lymph nodes.


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Blood grouping and Rh typing andcross matching.

Upper gastrointestinal endoscopy :

In case of massive bleeding Endoscopy

should be carried out by an experienced

operator as soon as the patient isresuscitated.

For patient with mild bleeding, endoscopy

should be carried out on the next morning

after admission.

Occult Blood Test:

Normally 2.5 blood is lost per day.

Blood loss between 50-100 ml /day will

produce melaena.

OBT detects amount between 10-50

mL/d.


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Specific treatment:

Peptic Ulcers:

Endoscopic hemostastasis

Medical management by H2 antagonist or PIP Surgical treatment

Esophageal varices:

Endoscopic control by electro-coagulation or

injectionMedical treatment for Portal hypertension..


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Specific treatment:

Gastric erosions:

Endoscopic hemostastasis

Medical management by H2 antagonist or PIP

Surgical treatment

Mallory-Weiss Tear:

Endoscopic treatment

If fails, gastrostomy and repair of the tear.

Malignancy:

Should be treated appropriately


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Upper GIBleeding

MassiveHemorrhage

Resuscitation

Endoscopy

VaricesUlcer ErosionsMallory-

WeissMalignancy

ChronicBleeding

Routine Inv

Endoscopic

hemostastasis

Medical

management by H2

antagonist or PIP

Surgical treatment

Endoscopic control by

electro-coagulation or

injectionMedical treatment for

Portal hypertension.

Endoscopic

treatment

If fails,gastrostomy

and repair of

the tear.

Should be treated

appropriately

Endoscopic

hemostastasis

Medical

management by

H2 antagonist or

PIP

Surgical

treatment


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Upper Gastro Intestinal Bleeding 632

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