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8/13/2019 Upper Gastro Intestinal Bleeding 632
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UPPER GASTROINTESTINAL
HEMORRHAGE
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.
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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
Peptic Ulcer45%
Esophageal
varices
20%
Gastritis
20%
Mallory-
Weiss
syndrome
10%
Uncommoncauses
5%
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Gastric Ulcer Duodenal Ulcer Ca-Stomach
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Esophageal varices Gastritis
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Mallory-Weiss Tear
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Hematemesis
Vomiting of blood is common when bleeding originates fromStomach 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 of Haemby 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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Initial assessment and management goals:
Assessment of the status of the circulatory system and
replace blood loss as necessary.
Determine the amount and rate of bleeding.
Slow or stop the bleeding by ice-water lavage
Discover the lesion responsible for the episodes.
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, ulcerdisease, 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
spider angiomata,
gynecomastia,
splenomegaly,
ascites,
pedal edema
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 andcross matching.
Upper gastrointestinal endoscopy :
In case of massive bleeding Endoscopy
should be carried out by an experienced
operator as soon as the patient isresuscitated.
For patient with mild bleeding, endoscopy
should be carried out on the next morning
after admission.
Occult Blood Test:
Normally 2.5 blood is lost per day.
Blood loss between 50-100 ml /day will
produce melaena.
OBT detects amount between 10-50
mL/d.
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Specific treatment:
Peptic Ulcers:
Endoscopic hemostastasis
Medical management by H2 antagonist or PIP Surgical treatment
Esophageal varices:
Endoscopic control by electro-coagulation or
injectionMedical treatment for Portal hypertension..
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Specific treatment:
Gastric erosions:
Endoscopic hemostastasis
Medical management by H2 antagonist or PIP
Surgical treatment
Mallory-Weiss Tear:
Endoscopic treatment
If fails, gastrostomy and repair of the tear.
Malignancy:
Should be treated appropriately
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Upper GIBleeding
MassiveHemorrhage
Resuscitation
Endoscopy
VaricesUlcer ErosionsMallory-
WeissMalignancy
ChronicBleeding
Routine Inv
Endoscopic
hemostastasis
Medical
management by H2
antagonist or PIP
Surgical treatment
Endoscopic control by
electro-coagulation or
injectionMedical 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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