1 / 10

Bleeding from the Gut Clinical approach

Bleeding from the Gut Clinical approach. Severity Vital signs Haematocrit Beware ongoing losses Acute onset or chronic blood loss Fe deficiency Stigmata of disease Failure to thrive and grow Purpura Liver and spleen. Site of bleeding. Haematemesis Fresh blood

monita
Download Presentation

Bleeding from the Gut Clinical approach

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. Bleeding from the GutClinical approach • Severity Vital signs Haematocrit Beware ongoing losses • Acute onset or chronic blood loss Fe deficiency • Stigmata of disease Failure to thrive and grow Purpura Liver and spleen

  2. Site of bleeding • Haematemesis Fresh blood swallowed, rapid haemorrhage Altered - “coffee ground” gastric acid

  3. Site of bleeding • Bleeding per rectum Fresh blood not mixed with stool low rectum and anus Fresh blood with mucus - dysentery colon and rectum Jellied dark blood intussusception Melaena - tarry black bleeding from higher up

  4. Bleeding from the gut • Bleeding tendency Vitamin K deficiency Hepatic failure Disseminated intravascular coagulation septicaemia, necrotising enterocolitis Thrombocytopaenia haemolytic uraemic syndrome Vasculitis - Henoch Schonlein purpura

  5. Bleeding from the Gut • Swallowed blood Maternal blood swallowed intrapartum Apt test Nose bleed Mouth and pharynx • Oesophagus Varices (portal hypertension) Oesophagitis (peptic or other) Mallory-Weiss tear

  6. Bleeding from the Gut • Stomach Gastritis and erosions Ulcer (peptic, stress) • Small gut Meckel diverticulum Ulcers (peptic and inflammatory) Intussusception Volvulus Polyps

  7. Bleeding from the Gut • Large gut Dysentery (amoebic, bacterial) Intussusception Polyps Ulcerative colitis • Rectum and anus Varices Polyps Trauma Anal fissure

  8. Bleeding from the gutManagement • Resuscitation as required • Stop the bleeding mostly spontaneous vitamin K blood component therapy emergency endoscopic approach

  9. Bleeding from the GutManagement • Identify the site of haemorrhage History Character of blood Upper gut: endoscopy Lower gut: contrast studies isotope scan “Meckel scan” endoscopy • Identify and manage aetiology • Follow-up for recurrence

  10. Dysentery • Mucosal invasion or toxin mediated inflammation with necrosis bacteria - shigella, Esch.coli, others Entamoeba histolytica, trichiuris • Fever, abdominal pain, extraintestinal features • Sometimes onset in “gastro-like” fashion • Major complications

More Related