management of upper gi bleed
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I/V access with large bore cannula Basic investigations-blood count,routine
biochemistry,cross match blood Hourly measurements of Bp,pulse and urine
output.. i/v colloids or crystalloids –pt with hypotension
and tachycarda Transfuse with blood Endoscopy for diagnosis & Rx Iv PPI therapy for bleeding peptic ulcer
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0.9 % saline Vasopressor(terlipressin) Prophylactic antibiotics Emegency endoscope Variceal band ligation Proton pump inhibitor Phosp[hate enema/lactulose enema
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ENDOSCOPIC THERAPY with * Bipolar electro coagulation * Heater probe
* Injection therapy - Absolute alcohol - 1:10000 epinephrine - Clips
High dose constant infusion of iv PPI E.g. Omeprazole – 80 mg bolus & 8 mg/hr infusion
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Eradication of H.Pylori infection
Discontinue NSAIDS & acids
If NSAIDS have to be used, use along with PPI
Use selective COX-2 inhibitors like Coxib or traditional NSAIDS + Coxib
Coxib + PPI : further significant decrease in ulcers and recurrent bleeding.
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Mostly bleeding stops spontaneously ( Recurrence is only 0-7 % )
Endoscopic therapy is only for actively bleeding Mallory weiss tear.
Angiographic therapy with embolization & operative therapy with over sewing of tear can be done ( but only required rarely )
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I. Vasoconstrictors (somatostatin, octreotide, terlipressin) iv terlipressin infusion at 2 mg 6th hourly, generalized vasoconstriction leading to decreased blood flow to venous system.
II. Baloon tamponade – Triple lumen or Four lumen tube with esophageal and gastric balloons. (Always intubate the patient prior to this procedure to prevent aspiration)
III. Endoscopic variceal liagation[Band ligation]
IV. SclerotherapyV. Antibiotic therapy
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Quinolones – for patients with cirrhosis decreases the bacterial infection & mortality.
Non selective Beta blockers – Propranalol, Nadolol
For recurrent esophageal bleeding – c/c therapy with beta blocker + endoscopic ligation
If not subsided with medical therapy, Go for:
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INVASIVE THERAPY:
TIPss (Transjugular intrahepatic portosystemic shunt)
A/E : Hep encephalopathy, shunt stenosis in 1 yr
Vascular ectasias are treated by endoscopic therapy
Estrogen / progesterone components are used in vascular ectasias
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avoiding the long-term use of alcohol, NSAIDs, coffee, high-fat foods and drugs
Reducing stress through relaxation techniques
Antacids, H2 blockers, PPIs
Triple therapy: 2 antibiotics + a PPI is commonly used to treat H. Pylori related gastritis
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Thank you….