Upper gi bleed

download Upper gi bleed

of 26

  • date post

    11-Feb-2017
  • Category

    Education

  • view

    345
  • download

    2

Embed Size (px)

Transcript of Upper gi bleed

Evaluation of Upper Gastrointestinal Bleed

AnatomyUpper Gastrointestinal tract is proximal to ligament of Treitz.

Common causes :Oesophageal : Gastric :Duodeal :

Oesophageal varicesGastric ulcerUlcerOesophagitisGastric cancersVascular malformation (Aorto-entric fistulae)

oesophageal cancerGastritisHemobilia

Mallory-Weiss tearGastric varicesHemosuccus pancreaticus

Oesophageal ulcerPortal hypertension gastropathySevere superior mesentric artery syndromeGastric Antral Vascular Ectasia (GAVE)

Common causes :

types :VARICEAL BLEEDING

NON VARICEAL BLEEDING

Clinical presentationHematemesisMelenaHematocheziaOccult GI bleedingAnaemiaShock

Approach :Initial assessment and resuscitation. History - Alcoholism, drugs, weight loss, anorexia.Physical examination + Signs of liver cell failureInvestigationsDiagnosisTreatment

Clinical presentationHistory

Lab investigations :CBC- Hb, Platelet count.PCVCoagulation profileSerum electrolytesBUN/creatinine ratio 30Blood grouping and cross match

Lab investigations :ECGStool routine (occult blood)HIV, HbsAg, Anti HCVRFTLFTGastrin levels

EndoscopyEsophagogastroduodenoscopy (EGD)*Video capsule endoscopyPush EnteroscopyDeep EnteroscopySingle/double ballon.spiral endoscopy.

radiologic imagingMesentric Angiography

Radionuclide scanning

CT enterography and CT angiography

treatmentMedical

Endoscopic

Balloon tamponade

surgeryPriority:

Control the Haemorrhage

variceal bleedingEsophagealEndoscopic- EVL, ESTBalloon Tamponade- Sengstaken Blakemore tubeSurgical- TIPS, Liver transplant

variceal bleedingGastricEndoscopicBalloon Tamponade- Linton Nachalas tubeSurgery- TIPS, Liver transplant

non variceal bleedingPeptic Ulcer Disease (PUD)Medical.EndoscopicAngiographic Embolisation.Surgery.

modalities for endoscopic therapyInjection TherapyEpinephrineHypertonic salineSclerosant- Absolute alcohol, polidoconolTissue adhesive- cyanoacyralateThermal TherapyContact- HP, BipolarNon Contact- APC, Nd:YAG laserMechanical TherapyEndoclipsEndoscopic band lgationCombination Thepary

Thank you