UPPER GI BLEEDS. Bleeding from a gastrointestinal source proximal to the ligament of Treitz which...
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Transcript of UPPER GI BLEEDS. Bleeding from a gastrointestinal source proximal to the ligament of Treitz which...
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UPPER GI BLEEDS
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Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno-jejunal flexture.
Definition
Haematemesis or Malaena Abdo pain, hypotension (fatigue etc), purpura,
liver pathology stigmata (spleno-hepato- megaly, spider naevi, jaundice, hepatic flap
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DDx
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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
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Correct any clotting abnormalities – Vit K? Warfarin?
Vasopressin PPI Urgent Endoscopy
– adrenaline/banding (arrests bleeding)
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LOWER GI BLEEDS
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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.
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Causes
Causes of lower GI haemorrhage in adults Percentage of pts
Diverticular disease-Diverticulosis/diverticulitis of small intestine-Diverticulosis/diverticulitis of colon
60%
IBD-Crohn's disease of small bowel, colon, or both-Ulcerative colitis -Noninfectious gastroenteritis and colitis
13%
Benign anorectal diseases-Hemorrhoids -Anal fissures -Anal fistulas
11%
Neoplasia-Malignant neoplasia of small intestine-Malignant neoplasia of colon, rectum, and anus
9%
Coagulopathy 4%
Arteriovenous malformations (AVM) 3%
TOTAL 100%
Meckel diverticulum, intussusception, polyposis syndromes, and IBD are the common causes of GI bleeding in children and adolescents
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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.
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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
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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 mucoid lining; Dx:13C Urea breath test
Serological tests – IgG antibodies – 80% sensitive & specificEndoscopy: 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.
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Rx