1 / 12

Upper GI Bleeds

Upper GI Bleeds. Definition. Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno-jejunal flexture . . Haematemesis or Malaena

hayden
Download Presentation

Upper GI Bleeds

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Upper GI Bleeds

  2. Definition • Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno-jejunalflexture. • Haematemesis or Malaena • Abdo pain, hypotension (fatigue etc), purpura, liver pathology stigmata (spleno-hepato- megaly, spider naevi, jaundice, hepatic flap

  3. DDx

  4. Rx – Upper Bleeds • Resuscitate/ABC - hypovolemia: • Rapid history and examination, note age. • Monitor pulse and BP every 30 mins • Take blood for haemoglobin, urea, electrolytes and grouping; Establish IV access • Give blood transfusion/colloid if necessary • Indications: 1. If in shock: BP<100, pulse >100bpm 2.haemoglobin<10g/dL • Oxygen therapy for shocked patients

  5. Correct any clotting abnormalities – Vit K? Warfarin? • Vasopressin • PPI • Urgent Endoscopy – adrenaline/banding (arrests bleeding)

  6. Lower GI Bleeds

  7. Definition • The loss of blood from the GI tract distal to the ligament of Trietz. • This is the anatomical marker for the junction between the duodenum and the jejunum.

  8. Causes Meckeldiverticulum, intussusception, polyposis syndromes, and IBD are the common causes of GI bleeding in children and adolescents 

  9. Signs and Symptoms • Maroon/red stained stools (hematochezia) or bright red blood from the rectum. • Malaena may also occur but it points more towards upper GI bleeds. • Hypotension; tachycardia • Pallour, weakness, fainting and other signs of anaemia (if chronic) • Perform History and ask about IBD, weight loss, FHx of Ca, stomach pain, bleeding disorders, last period.

  10. Rx – Lower Bleeds • Resuscitation and initial assessment – same as in upper GIT bleeding • Localization of the bleeding site – using investigations such as rectal examination, proctoscopy, sigmoidoscopy, colonoscopy, etc) • Therapeutic intervention to stop bleeding at the site. • Rx Anaemia

  11. H. Pylori and PUD • 95 % DU assoc. With H. Pylori; 80% GU; 4:1 • Risks: Smoking, NSAIDs, aspirin, steroids, increased acid secretion, increased gastric emptying, stress???, AGE (x>80) • Gram –ve, burrows into mucoidlining; • Dx:13C Urea breath test • Serological tests – IgG antibodies – 80% sensitive & specific • Endoscopy: Rapid urease test  gastric biopsies added to urea soln. with phenol red. If present  ph inc.↑ & causes colour change • Culture  biopsies cultured on special medium with antibiotic sensitivities.

  12. Rx

More Related