Upper Gi Bleeding

Upper GI Bleeding
Presented By,
Roll No. 61-65
SYNOPSIS Anatomy
Definition
Causes of UGI bleeding
History & Physical Examination
Investigations
Scoring systems
Management of acute episode
Variceal bleeeding & management
Nonvariceal bleeding & management
ANATOMY OF GIT
Arterial supply
of GIT
Venous drainage
1. Veins of portal venous
system
2. Systemic veins.
Blood from GIT enter the

liver via portal vein and
leave the liver via hepatic
veins to enter the inferior
vena cava
Venous drainage of the
abdominal part of the
gastrointestinal
tract,spleen,pancreas and
gallbladder except for the
inferior part of the rectum,is
through the portal system of
veins.
PORTAL-
SYSTEMIC
ANASTOMOSES
• Gastrointestinal bleeding describe every form of haemorrhage in the
GIT, from the pharynx to the rectum.
UGI Bleeding
Ligament of Treitz
LGI Bleeding
Definition
UGI Bleeding
Bleeding that occurs in the
digestive tract proximal to
the Ligament of Treitz;in
practice from the
oesophagus, stomach and
duodenum
Causes of Upper GIB
Clinical features
HEMATEMESIS
Vomiting of red fresh blood or coffee ground material
when gastric acid converts hemoglobin to acid hematin.
It should be differentiated from hemoptysis and bleeding
from pharynx
MELAENA
Passage of black tarry stools
Blood loss between 50-100 ml per day will produce
melaena.
The black color of stool is caused by hematin.
Can be seen in lower GI bleed or in non GI causes also.
Hematochezia
It is defined as passage of bright red blood from rectum.
 Seen in cases of severe hemorrhage

Abdominal Pain
Seen in cases of bleeding due to Carcinomas and peptic

ulcers.
 Also seen in cases of erosive gastritis

Hematemesis without melena can be seen
in lesions proximal to the ligament of
treitz
Melaena without hematemesis is usually

seen in lesions distal to pylorus
History and Examination
History
Ask for history of alcohol and drug abuse
 Positive history in case of acute erosive gastritis
Ask for history of abdominal pain

 To rule out peptic ulcer
Ask for history of jaundice and liver cell faliure

 To rule out esophageal varices
History of Anaemia, weight loss and loss of appetite

 Probable cause : CA Stomach
GENERAL PHYSICAL EXAMINATION
Testicular atrophy seen in liver cirrhosis
Palpable left supraclavicular node in CA stomach
Arthritis with multiple joint involvement seen in acute erosive gastritis

due to NSAID intake.
Purpuric spots in cases of bleeding disorders.

Abdominal Examination
Palpable spleen and ascites : seen in portal hypertension
Palpable stomach mass seen in Carcinoma stomach
Tenderness in epigastrium seen in Peptic ulcer disease.

Assessment of hem0rrhage
Massive hemorrhage i.e. more than 1000 ml of blood as seen in portal

hypertension, acute erosive gastritis and chronic peptic ulcer
Moderate hemorrhage i.e. 500-1000 ml of blood seen in peptic ulcer
Mild hemorrhage i.e. less than 500 ml of blood as seen in causes other
than mentioned above
Clues regarding the cause of acute UGI bleeding
Bleeding etiology Leading History
Mallory -Weiss tear Multiple Emesis before hematemesis, alcoholism, retching
Esophageal ulcer Dysphagia, Odynophagia, GERD
Peptic ulcer Epigastric pain, NSAID or aspirin use
Stress gastritis Patient in an ICU, gastrointestinal bleeding occurring after admission,respiratory

failure,multiorgan failure, coagulopathy
y
Varices, portal Alcoholism, Cirrhosis of liver
gastropathy
Gastric antral Renal failure, cirrhosis

vascular ectasia
Malignancy Recent involuntary weight loss, dysphagia, cachexia,

early satiety
Angiodysplasia Chronic renal failure, hereditary hemorrhagic telangiectasia
Aortoenteric fistula Known aortic aneurysm, prior abdominal aortic aneurysm repair
INVESTIGATIONS
1. Full blood count (hb% & PCV
should be repeated at regular
intervals)
2. Blood grouping & cross matching
3. LFT ; prothrombin time ; blood

urea ; serum electrolytes
4. Ultrasound abdomen
5. Gastroscopy (to see the spurting
vessels, oozing , clot in the ulcer ,
collected blood in the lumen of
stomach
6. Angiography of coeliac trunk and
SMA
GASTROSCOPY
It is visualization of stomach , duodenum ,
oesophagus .
It can be done as an OP procedure.
Procedure :
It is done following 8 hours of fasting
Lignocaine is sprayed into the oral
cavity and gastroscope is passed
gently down the oesophagus.
Once the scope is inside the stomach,
air is inflated and different parts of the
stomach is visualized.
Airway:
• Secure to prevent aspiration
• Endotracheal tube & give oxygen
Breathing:
• support respiratory function
Circulation:
• Expand circulatory volume
• 2 large bore i.v. cannula
• RBC transfusion with the goal of maintaining the
hematocrit value to 30% or hemoglobin to 8 g/dL.
• Normal saline may be infused intravenously until
packed red blood cells are available for transfusion.
• Maintain systolic B.P. at equal or greater than 90mmHg
• Pressure agents like dopamine 2.5 to 10 mcg/kg/min,
and dobutamine 2.5 to 10 mcg/kg/min as infusion,
Noradrenalin 3mg. /h as infusion may be required,
as a last resort,to maintain peripheral perfusion.
• Correct any coagulopathy with :-
10 - 15 ml/kg of FFP (if PT INR > 1.5) and/or
platelet transfusions (if platelet count < 50,000/cu.mm)
• Monitor:
 Skin color, peripheral temperature
 Pulse Rate, BP
 Respiratory Rate, O2 saturation of blood
 Urine output (Foley’s Catheter)
TREATMENT OF SUSPECTED PEPTIC ULCER

BLEEDING:
• Start High dose , constant infusion IV PPIs (Omeprazole 80
mg
bolus and 8mg/ h infusion for 72 h)
Common Causes of Upper Gastrointestinal
hemorrhage
Non Variceal Bleed Portal hypertensive
bleeding
 Peptic ulcer disease 30%-50%
 Gastroesophageal varices
 Mallory-Weiss tears 15%-20% >90%
 Gastritis or duodenitis 10%-  Hypertensive portal
15% gastropathy, <5
%
 GAVE
 Isolated gastric
 Dienlafoy lesion
varices, rare
 Tumors 2%
Esophageal varices: a
view of the everted
esophagus and
gastroesophageal
junction, showing
dilated submucosal
veins (varices).
OESOPHAGEAL VARICES:
PORTAL HYPERTENSION
PRE INTRA POST
HEPATI HEPATI HEPATI
C • C
Cirrhosis C
• Portal • Budd-
vein • Schistoso chiari
thrombosi miasis syndrome
s • Sarcoido
• Splenic s • Right
vein is heart
thrombosi • Myeloprol failure
s iferative • Constricti
disorder ve
• Congenita
l hepatic pericarditi
fibrosis s 1
OESOPHAGEAL VARICES:
PATHOPHYSIOLOGY
Portal venous hypertension
Resistance to flow in portal venous system
Pressure
Portal systemic shunting

(Abnormal venous communication between portal system
and systemic venous circulation)
Appearing of large submucosal veins at lower end of
oesophagus and gastric fundus
Haemorrhage due to intravariceal

pressure

Upper Gi Bleeding

Uploaded by

Copyright:

Available Formats

Upper Gi Bleeding

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Upper Gi Bleeding

Uploaded by

Copyright:

Available Formats

Upper GI Bleeding

Blood from GIT enter the

 Seen in cases of severe hemorrhage

Seen in cases of bleeding due to Carcinomas and peptic

 Also seen in cases of erosive gastritis

Melaena without hematemesis is usually

Ask for history of abdominal pain

Ask for history of jaundice and liver cell faliure

History of Anaemia, weight loss and loss of appetite

Testicular atrophy seen in liver cirrhosis

Palpable left supraclavicular node in CA stomach

Arthritis with multiple joint involvement seen in acute erosive gastritis

Purpuric spots in cases of bleeding disorders.

Palpable spleen and ascites : seen in portal hypertension

Palpable stomach mass seen in Carcinoma stomach

Tenderness in epigastrium seen in Peptic ulcer disease.

Massive hemorrhage i.e. more than 1000 ml of blood as seen in portal

Moderate hemorrhage i.e. 500-1000 ml of blood seen in peptic ulcer

Esophageal ulcer Dysphagia, Odynophagia, GERD

Peptic ulcer Epigastric pain, NSAID or aspirin use

Stress gastritis Patient in an ICU, gastrointestinal bleeding occurring after admission,respiratory

Gastric antral Renal failure, cirrhosis

Malignancy Recent involuntary weight loss, dysphagia, cachexia,

Angiodysplasia Chronic renal failure, hereditary hemorrhagic telangiectasia

2. Blood grouping & cross matching

3. LFT ; prothrombin time ; blood

TREATMENT OF SUSPECTED PEPTIC ULCER

Resistance to flow in portal venous system

Portal systemic shunting

Haemorrhage due to intravariceal

You might also like