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    Upper GI Bleeding

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    Shishir Shrestha
    Upper GI bleeding can be caused by portal hypertension due to liver cirrhosis and other conditions. The most common causes of bleeding are peptic ulcers, oesophagitis, and gastric/duodenal erosions, but variceal bleeding affects around 13% of patients. Bleeding may present as hematemesis, melena, or hematochezia. Initial management involves resuscitation, transfusions, and GI consultation. Endoscopy is important to determine the source, and band ligation or sclerotherapy can control variceal bleeding. For failed medical/endoscopic management, TIPSS procedure, balloon tamponade, or surgery may be considered.

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    Upper GI Bleeding

    Uploaded by

    Shishir Shrestha
    38 views15 pages
    Upper GI bleeding can be caused by portal hypertension due to liver cirrhosis and other conditions. The most common causes of bleeding are peptic ulcers, oesophagitis, and gastric/duodenal erosions, but variceal bleeding affects around 13% of patients. Bleeding may present as hematemesis, melena, or hematochezia. Initial management involves resuscitation, transfusions, and GI consultation. Endoscopy is important to determine the source, and band ligation or sclerotherapy can control variceal bleeding. For failed medical/endoscopic management, TIPSS procedure, balloon tamponade, or surgery may be considered.

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    Upper GI bleeding can be caused by portal hypertension due to liver cirrhosis and other conditions. The most common causes of bleeding are peptic ulcers, oesophagitis, and gastric/duodenal erosions, but variceal bleeding affects around 13% of patients. Bleeding may present as hematemesis, melena, or hematochezia. Initial management involves resuscitation, transfusions, and GI consultation. Endoscopy is important to determine the source, and band ligation or sclerotherapy can control variceal bleeding. For failed medical/endoscopic management, TIPSS procedure, balloon tamponade, or surgery may be considered.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    38 views15 pages

    Upper GI Bleeding

    Uploaded by

    Shishir Shrestha
    Upper GI bleeding can be caused by portal hypertension due to liver cirrhosis and other conditions. The most common causes of bleeding are peptic ulcers, oesophagitis, and gastric/duodenal erosions, but variceal bleeding affects around 13% of patients. Bleeding may present as hematemesis, melena, or hematochezia. Initial management involves resuscitation, transfusions, and GI consultation. Endoscopy is important to determine the source, and band ligation or sclerotherapy can control variceal bleeding. For failed medical/endoscopic management, TIPSS procedure, balloon tamponade, or surgery may be considered.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 15

    Upper GI Bleeding

    secondary to portal HTN

    SHISHIR SHRESTHA
    Upper GI bleeding refers to bleeding from
    oesophagus, stomach, duodenum (i.e. Proximal to
    ligmanet of treitz)
    Portal hypertension is defined as portal venous
    pressure above 7 mm of Hg or portal pressure
    gradient above 5 mm of Hg. ( PPG = PVP IVC
    pressure)
    Portal HTN is caused by

    - liver cirrhosis(most common)


    - extrahepatic portal vein occlusion
    - intrahepatic veno-occlusive disease
    - occlusion of main hepatic veins( Budd- Chiari
    syndrome)
    Causes
    Cause of Bleeding Relative Frequency
    Peptic Ulcer 44
    Oesophagitis 28
    Gastritis/erosions 26
    Duodenitis 15
    Varices 13
    Portal hypertensive 7
    gastropathy
    Malignancy 5
    Mallory Weiss tear 5
    Vascular Malformation 3
    Other (e.g. Aortoenteric rare
    fistula)
    Characteristics of Bleeding
    1. Hematemesis suggests bleeding proximal to
    the ligament of Treitz. Bright red blood suggests
    moderate to severe bleeding that may be
    ongoing, coffee-ground emesis suggests slower
    bleed
    2. Melena usually due to an upper GI bleed
    3. Hematochezia most often with lower GI bleed,
    but can be seen with massive upper GI bleeding
    History
    Important to get a good history about factors
    that predispose patients to bleeding
    Examination in patients with GI bleeding
    Reduced level of consiousness
    Pale
    Cool peripheries
    Tachcardic and thready pulse
    Hypotensive with narrow pulse pressure
    Stigmata of chronic liver disease (palmer erythema,
    leukonychia, dupuytrens contracture, liver flap, jaundice,
    spider naevi, gynacomastia, shifting dullness/ascites)
    Digital rectal examination may reveal melaena, dark red
    blood, bright red blood
    INVESTIGATIONS
    BASIC INVESTIGATIONS
    FULL BLOOD COUNT thrombocytopenia,
    occasional
    leucopenia(hypersplenism),anemia(bleeding)
    Hb LEVEL
    LIVER FUNCTION TEST- evidence of chronic
    liver disease
    PROTHROMBIN TIME - increased in liver
    diseases or in anti coagulation therapy
    CROSS MATCHING
    USEFUL INVESTIGATIONS
    Endoscopic examination of upper GIT
    - most useful
    - to determine whether gastro-oesophageal
    varices are present.
    USG
    - shows features of portal hypertensionsuch as
    splenomegaly and collateral vessels.
    - Can sometimes indicate the cause like liver
    disease or portal vein thrombosis.
    CT scan and MRI angiography
    can identify the extent of portal vein
    clot and are used to identify hepatic
    vein patency,
    Management of Variceal bleeds
    EMERGENCY MANAGEMENT
    Closely monitor airway, clinical status, vital
    signs, cardiac rhythm
    Two large bore IV lines (16 gauge or larger)
    Bolus infusions of isotonic crystalloid
    Adequate resuscitation is essential prior to
    endoscopy or other intervention.
    Transfusion
    - transfuse for a Hgb <7, active bleeding or
    hemodynamic instability
    Triage ICU vs Wards
    Hemodynamic instability or active bleeding > ICU
    Immediate GI consult
    Drugs
    Propanolol used in context of primary prevention
    (in those found to have varices to reduce risk of
    first bleed)
    Somatostatin/octreotide vasoconstricts
    splanchnic circulation and reduces pressure in
    portal system
    Terlipressin vasoconstricts splanchnic circulation
    and reduces pressure in portal system
    Endoscopy
    Band ligation
    Injection sclerotherapy
    Balloon
    tamponade sengstaken-
    blakemore tube
    as temporary measure if failed endoscopic
    management
    Radiological
    procedure used if
    failed medical/endoscopic Mx
    Selective catheterisation and embolisation of
    vessels feeding the varices
    TIPSS procedure: transjugular intrahepatic porto-
    systemic shunt
    shunt between hepatic vein and portal vein branch to
    reduce portal pressure and bleeding from varices):
    performed if failed medical and endoscopic management
    Can worsen hepatic encephalopathy
    TIPSS

    Sengstaken-Blakemore Tube
    Surgical
    Surgical porto-systemic shunts (often spleno-renal)
    Liver transplantation (patients often given TIPP/surgical shunt
    whilst awaiting this)
    Surgical porto-systemic shunt (spleno-renal shunt)
    THANK YOU

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