Upper Gastrointestinal Bleeding

Dr Praveen Kumar

Definition

Bleeding proximal to the ligament of trietze

Anatomy

PresentationHaematemesisMalenaHaematocheziaAnemiaFecal Occult Blood

Natural History75% of cases will stop spontaneously25% Will

Require surgeryDevelop complicationsDie

Amount and Rate of Bleeding

Common CausesPeptic ulcer

Duodenal ulcerGastric ulcer

GastritisOesophagitisMallory – Weiss syndromeEsophageal varices

Uncommon CausesGastric carcinomaPancreatitisHaemobiliaDuodenal diverticulum

Immediate Management Airway + Oxygen BreathingCirculationNg Tube?Catheter?

Lab InvestigationsFBCU & EClottingCross match

HistoryMode of bleedingRateDurationFrequencyCo-morbiditiesBleeding tendenciesDrugs,warfarin,NSAID,

ExaminationPhysical examClinical diagnosis of the cause is possible in

60% of cases

Assessment of the blood loss

CLASS 1 CLASS 2 CLASS 3 CLASS 4

Blood loss 750-15%

750-150025-30%

1500-200030-40%

>2000>40%

Pulse rate <100 >100 >120 >140

BP N N D D

Pulse pressure N D D D

RR 14-20 20-30 30-40 >35

UOP >30 20-30 5-15 Negligible

CNS/MENTAL SlightlyAnxious

MildlyAnx

Anx/conf Conf/leth

Fluid replacement Crystalloid Crystalloid Cryst/blood Cryst/blood

Estimated fluid and blood losses for 70 kg man

InvestigationsEndoscopy: OGD, Colonoscopy,enteroscopyConstruct studyCT – ScanAngiography

GastroscopyEndoscopy should be done within 24 H

Adrenaline injectionHeat probeArgon plasma coagulation

SurgeryFor uncontrollable bleeding by endoscopy (Severe upper GIT bleeding)

Risk FactorsShock on presentationHb < 8 gmAge > 60 YGastric ulcerRebleedingSpurting vesselDeficiency of blood

Endoscopic erosive gastritis

Gastritis produced by aspirin and other nonsteroidal anti-inflammatory drugs

Benign gastric ulcer

Duodenal ulcer

Cardia carcinoma

Mallory-Weiss tear

Two ulcers in the mid oesophagus

Large esophageal varices

Thanks