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    Upper Gastrointestinal Bleeding

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    Dr.Sathaporn Kunnathum
    Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, varices, Mallory-Weiss tears, or esophagitis. It typically presents as hematemesis, melena, or maroon stools. Evaluation involves stabilizing the patient, assessing vitals, performing lab tests, and using nasogastric lavage to help locate the source of bleeding. Treatment consists of fluid resuscitation, coagulation factor replacement if needed, endoscopy for diagnosis and potential intervention, and surgery in some cases of severe or recurrent bleeding.

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    Upper Gastrointestinal Bleeding

    Uploaded by

    Dr.Sathaporn Kunnathum
    3K views24 pages
    Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, varices, Mallory-Weiss tears, or esophagitis. It typically presents as hematemesis, melena, or maroon stools. Evaluation involves stabilizing the patient, assessing vitals, performing lab tests, and using nasogastric lavage to help locate the source of bleeding. Treatment consists of fluid resuscitation, coagulation factor replacement if needed, endoscopy for diagnosis and potential intervention, and surgery in some cases of severe or recurrent bleeding.

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    Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, varices, Mallory-Weiss tears, or esophagitis. It typically presents as hematemesis, melena, or maroon stools. Evaluation involves stabilizing the patient, assessing vitals, performing lab tests, and using nasogastric lavage to help locate the source of bleeding. Treatment consists of fluid resuscitation, coagulation factor replacement if needed, endoscopy for diagnosis and potential intervention, and surgery in some cases of severe or recurrent bleeding.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    3K views24 pages

    Upper Gastrointestinal Bleeding

    Uploaded by

    Dr.Sathaporn Kunnathum
    Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, varices, Mallory-Weiss tears, or esophagitis. It typically presents as hematemesis, melena, or maroon stools. Evaluation involves stabilizing the patient, assessing vitals, performing lab tests, and using nasogastric lavage to help locate the source of bleeding. Treatment consists of fluid resuscitation, coagulation factor replacement if needed, endoscopy for diagnosis and potential intervention, and surgery in some cases of severe or recurrent bleeding.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 24

    Upper Gastrointestinal Bleeding

    27 may 2009

    Sathaporn Kunnathum M.D.


    Overview
    • Cause of Gastrointestinal bleeding
    • Clinical Presentation
    • Evaluation
    • Treatment
    Introduction
    • Causes depend on site
    – UGI = proximal to ligament of Treitz
    – LGI = distal to ligament of Treitz
    Causes of Significant GI Bleeding
    Upper Percentage Lower Percentage
    Peptic ulcer dz 45 Diverticulosis 18-43

    Gastric Angiodysplasia 20-40


    erosions 23
    Unknown 11-32
    Varices 10
    Cancer/polyps 9-33
    Mallory-Weiss 7
    Rectal disease 8-9
    Esophagitis 6
    IBD 1-7
    Duodenitis 6
    Clinical Presentation
    • Most common = hematemesis, melena,
    hematochezia or black stools
    – Hematemesis associated with bleeding
    proximal to lig of treitz
    – Melena usually proximal to jejunum with
    greater than 4 hrs transit time
    • requires blood 50-100 mL
    Clinical Presentation
    – Hematochezia usually due to colonic source
    BUT UGIB > 1000 mL and less than 4 hours
    transit may be red or maroon
    • UGIB: 71% have melena, 56%
    hematemesis, 21% maroon stool
    Evaluation
    • First priority is ABCs
    • Intubation occasionally necessary for
    overwhelming UGIB
    • Aggressive fluid resuscitate if hemodynamic
    unstable = Mandatory to have 2 Large Bore I.V.
    or central access
    • While stabilizing, get initial history, place on
    monitor and start O2
    Evaluation
    • History:
    – Duration, quantity, color of blood, associated
    symptoms ,precipitating factor, history of GIB, alcohol,
    drugs use, underlying disease
    Evaluation
    • Physical Exam
    Vital signs
    – PR, BP, RR
    – Hypothermia with significant volume depletion
    Others
    – General appearance: pale?jaundice? conscious?
    – Skin: turgor, capillary refill, petechiae/purpura
    – Lungs/Heart
    – Abdominal exam
    – PR
    Evaluation
    • Laboratory
    – Hct
    – CBC,plt
    – PT/PTT for correctable coagulopathy
    – Cross match
    – Blood chemistry for azotemia/ARF/Acidosis
    – LFT
    – ABG if indicated
    Treatment
    • NPO
    • Always start with ABCs
    • O2
    • 2 Large bore IVs
    • Monitor
    • NG tube
    • Foley cath
    • ET tube ?
    Treatment
    • NG lavage
    – Essential to differentiate UGI vs. LGI
    – 10-15% of pts with hematochezia have UGIB
    Treatment
    • NG lavage, cont.
    – 79% sensitive for ACTIVE UGIB
    – Useful to assess for ongoing hemorrhage
    – Not therapeutic
    – Not harmful in varices or MW tear
    Treatment
    • NG lavage, additional notes
    – Must confirm placement of tube prior to
    lavage
    – Sterile lavage fluid not necessary
    – Lavage until clear
    Treatment
    • Fluid resuscitation
    – Crystalloid initially
    – PRC,Fresh whole blood, FFP, plt conc
    • Critical to monitor
    Treatment

    • Coagulation Defects - consider FFP, Vit K


    • Thrombocytopenic (<50,000 and
    bleeding) transfuse platelets
    • For severe bleeds - consult GI early as
    well as general surgery
    Treatment
    • Additional options
    – Empiric acid-suppressive therapy : PPI and
    H2 receptor antagonist
    – Octreotide - Besson in NEJM 1995 showed
    decreased rebleeding in varices after
    Octreotide - no change in mortality, however
    (50 mcg bolus, then 25-50/hr)
    Treatment
    • Sengstaken-Blakemore Tube
    – Generally not used except in dire circumstance
    – High rate of complications and death (14%, 3%)
    including aspiration, esophageal and gastric rupture,
    mucosal and nasal necrosis
    – Attempt only after failure of Octreotide as a bridge to
    endoscopy in pts exsanguinating from known varices
    – Need to be intubated prior to placement
    Treatment
    • Endoscopy
    – Most accurate tool for evaluating source of
    bleeding
    – Not usually necessary in first 12 hrs
    • no increase in diagnostic accuracy if done earlier
    – May be necessary if bleeding is ongoing,
    unresponsive to resuscitation or recurrent to
    dictate therapy
    • Intervention angiography
    Treatment
    • Surgery
    – 15-34% of patients with GIB require surgery
    – Mortality for emergency surgery is 23%
    • Thank you for your attention

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