Download - Aetiology of upper gi bleed

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Page 1: Aetiology of upper gi bleed

UPPER GI BLEED

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AETIOLOGY

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PEPTIC ULCER

• Breaks in the mucosal surface >5 mm

• 2 types-• Duodenal Ulcers • Gastric Ulcers

• NSAIDS H.Pylori

PEPTIC ULCER

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GASTRIC EROSIONS

• GASTRITIS• Alcohol intake• NSAID use• Stress

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ESOPHAGITIS

• Inflammation of esophageal mucosa

a) GERD

b) Barret Esophagus

c) Chemical Esophagitis-alcohol,acids,alkalis

d) Infectious esophagitis- HSV,CMV,fungal

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Mallory-Weiss tear• Longitudinal tears

• Alcoholics

• Symptoms :• Vomiting• retching • Coughing

HEAMATEMESIS

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ESOPHAGEAL VARICES

• Liver diseases– Cirrhosis

• Portal Hypertension

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NEOPLASMS

• Ca.esophagus-

Squamous cell Ca

Adeno Ca

• Ca.stomach-Second most common Tumor

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LESS COMMON CAUSES

• Vascular Malformations

Hereditary hemorrhagic telangiectasias

• Aorto-duodenal Fistula

• Hemosuccus pancreaticus

Bleeding from the bile duct or pancreatic duct

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CLINICAL PRESENTATION

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Bleeding - present in 5 ways.

1. Hematemesis - red blood or "coffee-ground" material.

2. Melena - black, tarry, foul-smelling stool.

3. Hematochezia - passage of bright red or maroon blood from the rectum.

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4. Occult GI bleeding –

absence of overt bleeding

fecal occult blood test - +ve

presence of iron deficiency.

5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea.

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I. HAEMATEMESIS

• vomiting of blood follows bleeding from esophagus ,stomach and duodenum( above the duodenal flexure)

COMMON CAUSES

i. Ruptured oesophageal varices

ii. Esophageal carcinoma

iii. Chronic gastric ulcer

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iv. Carcinoma stomach

v. chronic duodenal ulcer

vi. Mallory Weiss syndrome

LESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia

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• If the source of bleeding is above gastro-oesophageal sphincter ( eg : oesophageal varices) fresh blood wells up in mouth than being actively vomited

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Mallory – Weiss tear-

patient vomits several times

fresh blood only appears after the initial vomit

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• Sudden loss of > 20%

-tachycardia , hypotension, faintness and sweating

• Brisk hematemesis -from large vessel in an ulcer BRIGHT RED

• Bright red blood –naso or oro pharynx

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• Slower upper GI bleeding- mixing of blood with gastric juice

darker, like that of ground coffee

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II. MELAENA

- black , tarry stools containing occult blood

-Upper GI bleeding -Haemorrhage from right side of

colon -appx 60 ml of blood - single

black coloured stool

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Blood for 14 hrs in the GI tract• Characteristics

i. Black tarry stool- due to production of acid haematin

ii. Offensive odour - acid haematin is altered by bacteria

iii. Semisolid in consistency

iv. Usually associated with vertigo , dizziness, syncopal attack during defecation

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• Causes – all the causes of haematemesis may produce melaena

• Rarely, swallowed blood give rise to melaena: epistaxis

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