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    Mx. of Acute Git Haem.

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    khadzx
    This document discusses the management of acute gastrointestinal (GIT) haemorrhage. It covers causes of upper and lower GIT bleeding, pathophysiology, investigations including endoscopy, and treatment approaches. Treatment involves initial resuscitation and medical management for 50-75% of cases. For those where bleeding does not stop, options include non-operative interventions like endoscopy or radiology, or surgical interventions like ligation or resection. The goal is to stop the bleeding through the least invasive means possible.

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    Mx. of Acute Git Haem.

    Uploaded by

    khadzx
    48 views17 pages
    This document discusses the management of acute gastrointestinal (GIT) haemorrhage. It covers causes of upper and lower GIT bleeding, pathophysiology, investigations including endoscopy, and treatment approaches. Treatment involves initial resuscitation and medical management for 50-75% of cases. For those where bleeding does not stop, options include non-operative interventions like endoscopy or radiology, or surgical interventions like ligation or resection. The goal is to stop the bleeding through the least invasive means possible.

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    This document discusses the management of acute gastrointestinal (GIT) haemorrhage. It covers causes of upper and lower GIT bleeding, pathophysiology, investigations including endoscopy, and treatment approaches. Treatment involves initial resuscitation and medical management for 50-75% of cases. For those where bleeding does not stop, options include non-operative interventions like endoscopy or radiology, or surgical interventions like ligation or resection. The goal is to stop the bleeding through the least invasive means possible.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    48 views17 pages

    Mx. of Acute Git Haem.

    Uploaded by

    khadzx
    This document discusses the management of acute gastrointestinal (GIT) haemorrhage. It covers causes of upper and lower GIT bleeding, pathophysiology, investigations including endoscopy, and treatment approaches. Treatment involves initial resuscitation and medical management for 50-75% of cases. For those where bleeding does not stop, options include non-operative interventions like endoscopy or radiology, or surgical interventions like ligation or resection. The goal is to stop the bleeding through the least invasive means possible.

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    Download as PPT, PDF, TXT or read online from Scribd
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    You are on page 1of 17

    MANAGEMENT OF ACUTE

    GIT HAEMORRHAGE

    G. JUMBI

    1
    1. CAUSES
    • 1. General causes (bleeding
    disorders).
    • 2. Local causes (see below).

    Local Causes - Upper GIT


    Haemorrhage.
    • Peptic ulcers (Duodenal Ulcer and
    gastric ulcers
    50-75%
    Gastric erosion (Haemorrhagic gastric
    10% 2
    2. CAUSES
    Local Causes - Lower GIT
    Haemorrhage.
    • Diverticular disease
    50%
    • Haemorrhoids
    • Colorectal carcinoma.
    • Polyps.
    • Colitis (e.g ulcerative colitis)
    •  3
    PATHOPHYSIOLOGY
    • COVERT SHOCK.
    • COMPENSATED SHOCK.
    • DECOMPENSATED SHOCK.
    Early decompensation.
    Severe decompensation.
    • UNRESPONSIVE SHOCK.
    • IRREVERSIBLE SHOCK.
    4
    HISTORY & PHYSICAL
    EXAMINATION
    UPPER GIT BLEEDING.
    • HAEMATEMESIS.
    • MALAENNA.
    • PER RECTAL BLEEDING.
    • SHOCK.
    • Hx OF PUD.
    • Hx OF NSAIDs.
    • Hx OF MALLORY-WEISS SYNDROME.
    • SIGNS OF PORTAL HPT.
    5
    HISTORY & PHYSICAL
    EXAMINATION
    LOWER GIT BLEEDING.
    • TORRENTIAL PER RECTAL
    BLEEDING.
    • SHOCK.
    • PROCTOSCOPY.

    6
    INVESTIGATIONS.
    • BASELINE INVESTIGATIONS.
    Hb, Hct, Group & X-Match,Coag.screen.
    • ECG.
    • ENDOSCOPY.
    OGD.
    Proctoscopy.
    Sigmoidoscopy.
    Colonoscopy.

    7
    2. INVESTIGATIONS.
    • BARIUM CONTRAST STUDIES.
    Barium meal.
    Barium enema (double contrast
    studies).
    • ANGIOGRAPHY/interventional
    radiology).
    Arteriography (coeliac & mesenteric).
    Venography (portal vein, splenic vein, varices.

    8
    TREATMENT.
    • MEDICAL MANAGEMENT 50-75%.

    • NON – OPERATIVE HAEMOSTASIS


    HAEMOSTASIS INTERVENTIONS.

    • SURGICAL INTERVENTIONS.

    9
    1. MEDICAL MANAGEMENT.
    RESUSCITATION (Shocked patients).
    AIRWAY.
    BREATHING.
    CICULATION ( CARDIAC ARREST
    & MANAGEMENT OF SHOCK).

    10
    2. MEDICAL MANAGEMENT.
    MANAGEMENT OF HAMORRHAGIC
    SHOCK.
    • THE SHOCK POSITION.
    • DRUGS (O2, NaHCO3, HCT).
    • GP & X-MATCH.
    • I.V. LINE
    • BLOOD REPLACEMENT.
    11
    CLINICAL CORRELATION
    Clinical correlation % of Blood (For a 70 Kg Blood
    (Severity of shock) lost (Adult Required

    <10%-15% <750 ml No blood


    . Shock absent (covert shock): PR = 60-100/min required
    BP=110-140;

    bsent vasoconstriction(VC);

    rine output (UO) = 40 – 50 ml/hr.

    2. Compensated Shock: PR = 100-120/ml 10% - 30% 750ml— ½L–L


    BP = 110-140;VC = +; UO =30-40 ml/hr. 11/2L

    30 – 50% 1½l–2½L 1
    . Early decompensation: PR = 120-140

    P = 70-110; VC = ++;UO = <30ml/hr

    4. Severe decompensation: PR =>140/min > 50% 2½-3½ > 3L


    BP = 0-70; VC = +++; UO = Zero
    12
    3. MEDICAL MANAGEMENT.
    MONITORING OF SHOCK.
    • CLINICAL MONITORING.
    • URINARY OUTPUT.
    • NGT / RECTAL TUBE MONITORING.
    • BLOOD GAS ANALYSIS
    • CVP LINE.
    • LVFP (FCT, PAWP).
    13
    OUTCOME OF MEDICAL
    TREATMENT.
    • BLEEDING STOPS 50-75%.
    OGD / BA. STUDIES AFTER 24
    HOURS.
    • BLEEDING FAILS TO STOP 25-50%
    1. NON-OPERATIVE
    INTERVENTION.
    2. SURGICAL INTERVENTION.

    14
    NON – OPERATIVE
    INTERVENTIONS.
    • EMERGENCY ENDOSCOPY (UPPER GIT
    ONLY). (Coagulation, sclerotherapy,
    polypectomy).

    • TAMPONADE (VARICES).

    • INTERVEVNTIONAL RADIOLOGY:
    ARTERIAL EMBOLIZATION.
    VENOUS EMBOLIZATION.
    15
    SURGICAL INTERVENTION.
    (LAPAROTOMY).
    Duodenal ulcer–ligation of the bleeder +
    Vagotomy &
    Drainage.
    Gastric ulcer – Ligation of bleeder +
    Partial gastrectomy.
    Mallory–Weiss – Gastrotomy, ligation of
    the bleeder +
    repair.
    Oesophageal varices –Transection of
    oesophagus
    (or the
    16
    stomach).
    2.SURGICAL INTERVENTION
    • Ca. stomach - Gastrectomy (total or partial).
    • Diverticular disease- Segmental colectomy
    + colostomy.
    • C.A. colon – Partial colectomy +
    colostomy.
    • Polyps - Colotomy + polypectomy.

    17

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