upper gastrointestinal bleeding - diagnosis and management
DESCRIPTION
Upper gastrointestinal bleeding is a fatal condition, if not tackle in time. Causes, diagnosis and management are being discussed in the presentation.TRANSCRIPT
Upper Gastrointestinal Bleeding
Dr Praveen Kumar
Definition
Bleeding proximal to the ligament of trietze
Anatomy
PresentationHaematemesisMalenaHaematocheziaAnemiaFecal Occult Blood
Natural History75% of cases will stop spontaneously25% Will
Require surgeryDevelop complicationsDie
Amount and Rate of Bleeding
Common CausesPeptic ulcer
Duodenal ulcerGastric ulcer
GastritisOesophagitisMallory – Weiss syndromeEsophageal varices
Uncommon CausesGastric carcinomaPancreatitisHaemobiliaDuodenal diverticulum
Immediate Management Airway + Oxygen BreathingCirculationNg Tube?Catheter?
Lab InvestigationsFBCU & EClottingCross match
HistoryMode of bleedingRateDurationFrequencyCo-morbiditiesBleeding tendenciesDrugs,warfarin,NSAID,
ExaminationPhysical examClinical diagnosis of the cause is possible in
60% of cases
Assessment of the blood loss
CLASS 1 CLASS 2 CLASS 3 CLASS 4
Blood loss 750-15%
750-150025-30%
1500-200030-40%
>2000>40%
Pulse rate <100 >100 >120 >140
BP N N D D
Pulse pressure N D D D
RR 14-20 20-30 30-40 >35
UOP >30 20-30 5-15 Negligible
CNS/MENTAL SlightlyAnxious
MildlyAnx
Anx/conf Conf/leth
Fluid replacement Crystalloid Crystalloid Cryst/blood Cryst/blood
Estimated fluid and blood losses for 70 kg man
InvestigationsEndoscopy: OGD, Colonoscopy,enteroscopyConstruct studyCT – ScanAngiography
GastroscopyEndoscopy should be done within 24 H
Adrenaline injectionHeat probeArgon plasma coagulation
SurgeryFor uncontrollable bleeding by endoscopy (Severe upper GIT bleeding)
Risk FactorsShock on presentationHb < 8 gmAge > 60 YGastric ulcerRebleedingSpurting vesselDeficiency of blood
Endoscopic erosive gastritis
Gastritis produced by aspirin and other nonsteroidal anti-inflammatory drugs
Benign gastric ulcer
Duodenal ulcer
Cardia carcinoma
Mallory-Weiss tear
Two ulcers in the mid oesophagus
Large esophageal varices
Thanks