Upper Gastro-Intestinal Bleeding
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UPPER GASTROINTESTINAL UPPER GASTROINTESTINAL HEMORRHAGE HEMORRHAGE Prof. Feroze Quader Dept. of Surgery BKZMC
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This presentation was prepared for undergraduate medical student of angladesh.
Transcript of Upper Gastro-Intestinal Bleeding
- 1. UPPER GASTROINTESTINALHEMORRHAGE 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.
3. 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 4. Gastric Ulcer Duodenal Ulcer Ca-Stomach 5. Esophageal varices Gastritis 6. Mallory-Weiss Tear 7.
- Hematemesis
- Vomiting of blood is common when bleeding originates from Stomach 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 ofHaemby 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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- Initialassessment andmanagement goals :
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- Assessment of the status of the circulatory systemand replace blood loss as necessary.
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- Determine the amount and rate of bleeding.
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- Slow or stop the bleeding by ice-water lavage
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- Discover the lesion responsible for the episodes.
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- 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, ulcer disease, 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
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- spider angiomata,
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- gynecomastia,
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- splenomegaly,
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- ascites,
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- pedal edema
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- 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 and cross matching.
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- Uppergastrointestinal endoscopy :
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- In case of massive bleeding Endoscopy should be carried out by an experienced operator as soon as the patient is resuscitated.
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- For patient with mild bleeding, endoscopy should be carried out on the next morning after admission.
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- Occult Blood Test:
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- Normally 2.5 blood is lost per day.
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- Blood loss between 50-100 ml /day will produce melaena.
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- OBTdetects amount between 10-50 mL/d.
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- Specific treatment :
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- Peptic Ulcers:
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- Endoscopic hemostastasis
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- Medical management by H2 antagonist or PIP
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- Surgical treatment
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- Esophageal varices:
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- Endoscopic control by electro-coagulation or injection
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- Medical treatment for Portal hypertension..
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- Specific treatment :
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- Gastric erosions:
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- Endoscopic hemostastasis
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- Medical management by H2 antagonist or PIP
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- Surgical treatment
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- Mallory-Weiss Tear:
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- Endoscopic treatment
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- If fails, gastrostomy and repair of the tear.
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- Malignancy:
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- Should be treated appropriately
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- Endoscopic hemostastasis
- Medical management by H2 antagonist or PIP
- Surgical treatment
- Endoscopic control by electro-coagulation or injection
- Medical 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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