Evaluation of Upper Gastrointestinal

Bleed

Anatomy• Upper Gastrointestinal tract is proximal to

ligament of Treitz.

Common causes :Oesophageal : Gastric : Duodeal :

Oesophageal varices Gastric ulcer Ulcer

Oesophagitis Gastric cancers Vascular malformation (Aorto-entric fistulae)

oesophageal cancer Gastritis Hemobilia

Mallory-Weiss tear Gastric varices Hemosuccus pancreaticus

Oesophageal ulcer Portal hypertension gastropathy

Severe superior mesentric artery

syndrome

Gastric Antral Vascular Ectasia (GAVE)

Common causes :

types :

• VARICEAL BLEEDING

• NON VARICEAL BLEEDING

Clinical presentation• Hematemesis

• Melena

• Hematochezia

• Occult GI bleeding

• Anaemia

• Shock

Approach :• Initial assessment and

resuscitation.

• History - Alcoholism, drugs, weight loss, anorexia.

• Physical examination + Signs of liver cell failure

• Investigations• Diagnosis

• Treatment

Clinical presentation

• History

Lab investigations :• CBC- Hb, Platelet count.

• PCV

• Coagulation profile

• Serum electrolytes

• BUN/creatinine ratio ≥ 30

• Blood grouping and cross match

Lab investigations :• ECG

• Stool routine (occult blood)

• HIV, HbsAg, Anti HCV

• RFT

• LFT

• Gastrin levels

Endoscopy• Esophagogastroduodenoscopy (EGD)*

• Video capsule endoscopy

• Push Enteroscopy

• Deep Enteroscopy

• Single/double ballon.

• spiral endoscopy.

radiologic imaging• Mesentric Angiography

• Radionuclide scanning

• CT enterography and CT angiography

treatment• Medical

• Endoscopic

• Balloon tamponade

• surgery

Priority:

Control the Haemorrhage

variceal bleedingEsophageal

• Endoscopic- EVL, EST

• Balloon Tamponade- Sengstaken Blakemore tube

• Surgical- TIPS, Liver transplant

variceal bleedingGastric

• Endoscopic

• Balloon Tamponade- Linton Nachalas tube

• Surgery- TIPS, Liver transplant

non variceal bleedingPeptic Ulcer Disease (PUD)

• Medical.

• Endoscopic

• Angiographic Embolisation.

• Surgery.

modalities for endoscopic therapyInjection Therapy

• Epinephrine• Hypertonic saline• Sclerosant- Absolute alcohol, polidoconol• Tissue adhesive- cyanoacyralate

Thermal Therapy

• Contact- HP, Bipolar• Non Contact- APC, Nd:YAG laser

Mechanical Therapy

• Endoclips• Endoscopic band lgation

Combination Thepary

Thank you