acute upper gi bleed:
DESCRIPTION
Acute Upper GI Bleed:. Case 1. 64/C/M presented to the A&E with c/o SOBOE, giddiness and lethargy. He gives a history of passing out black tarry stools yesterday. He has been taking diclofenac sodium regularly due to bilateral knee pains. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/1.jpg)
Acute Upper GI Bleed:
![Page 2: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/2.jpg)
Case 1
64/C/M presented to the A&E with c/o SOBOE, giddiness and lethargy.
He gives a history of passing out black tarry stools yesterday.
He has been taking diclofenac sodium regularly due to bilateral knee pains.
He has also drinking alcohol regularly, i.e. 2 large bottle of beers daily.
![Page 3: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/3.jpg)
How important are the colour of his stools?
![Page 4: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/4.jpg)
What are the possible causes of his GI bleed?
![Page 5: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/5.jpg)
What other physical signs are helpful to determine the cause of GI bleed?
![Page 6: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/6.jpg)
Physical examination
The patient was found to be drowsy, with M5V3E3 (GCS 11/15)
BP was 95/70 mm Hg HR 110 bpm Peripheries was cold and clammy Pulse was feeble SpO2 95%
![Page 7: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/7.jpg)
What is the causes of the low GCS?
What is the significance of the vital signs recorded?
![Page 8: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/8.jpg)
You find that he has 8 spider naevis, absence of axillary hair and gross ascites.
He has a flapping tremor.
He also has multiple bruising over the extensor surfaces of his arms.
![Page 9: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/9.jpg)
What could be the other cause of his low GCS?
State the stages of hepatic encephalopathy.
![Page 10: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/10.jpg)
Suddenly, he develops haemataemesis. Do you insert a Ryle’s tube? State your
reasons for doing so.
![Page 11: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/11.jpg)
You check the vital signs again :– BP 84/50 mm Hg– HR 150 bpm– GCS M3V2E1 (6/15)– SpO2 89%
![Page 12: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/12.jpg)
Why has the vital signs worsened?
Why has he become more hypoxic?
![Page 13: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/13.jpg)
What do you do now? List down your approach to stabilizing this
patient.
![Page 14: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/14.jpg)
Investigation results
TWC 13.5 Hb 6.0 MCV 80 MCH 30 Plt 500 Explain the results above. Would you expect hypochromic microcytic
anemia?
![Page 15: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/15.jpg)
APTT 40 PT 15 INR 1.8
What are the possible causes?
![Page 16: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/16.jpg)
What other tests to order to elucidate the cause?
![Page 17: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/17.jpg)
Urea 28 Creat 140 Na 130 K 3.7
Explain the results above.
![Page 18: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/18.jpg)
TP 60, alb 23 ALT 878 ALP 30
Explain the results.
![Page 19: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/19.jpg)
RBS 3.0
Why?
![Page 20: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/20.jpg)
What blood products do you want to give and why?
What is the target Hb in this patient?
![Page 21: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/21.jpg)
List all the problems / diagnosis of this patient.
![Page 22: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/22.jpg)
What is the definitive treatment of this patient?
Are there any drugs which helps reduce bleeding?
![Page 23: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/23.jpg)
Are antibiotics needed in this patient?
![Page 24: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/24.jpg)
What is the follow up care for this patient?
![Page 25: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/25.jpg)
Case 2
60 year old man presents with 1 week history of malaena and shortness of breath?
On examination he his pale and cachexic. Hb 9.0g/dL MCV 60 MCH28 PR showed malaena, examination of the
abdomen was unremarkable. BP 120/80 mm Hg HR 99 bpm
![Page 26: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/26.jpg)
What could be the possible causes of his UGIB?
What investigations would you send?
![Page 27: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/27.jpg)
Would you transfuse him with blood? What are the indications for blood
transfusion? How fast would you transfuse the blood? Do you need to give IV Frusemide as well?
![Page 28: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/28.jpg)
OGDS showed a Forrest IIc ulcer. What does this mean?
![Page 29: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/29.jpg)
How can the ulcer be treated endoscopically?
What drugs should the patient be given?
![Page 30: Acute Upper GI Bleed:](https://reader033.vdocuments.us/reader033/viewer/2022061602/56815d3c550346895dcb4250/html5/thumbnails/30.jpg)
Patient asks you what are the risks for OGDS. What do you say?