Upload
meducationdotnet
View
199
Download
0
Embed Size (px)
Citation preview
Upper Gastro-Intestinal Bleed
Oliver McLaren
GI Tract
Upper GI Tract• Anatomically consists of:
» Mouth» Pharynx» Oesophagus» Stomach
• Upper GI bleeding can include bleeding from the duodenum up to the ligament of Treitz, just before the junction between the duodenum and the jejunum
Ligament of Treitz
Epidemiology• Upper GI bleeding is a potentially life-
threatening and remains a common cause of hospitalisation
• Incidence is 100 cases per 100,000 people per year
• Upper GI bleeds are 4 times more common than Lower
• Overall mortality rate is 6-10 % overall
Upper GI Bleed Presentation• Upper GI bleeding presents in 2 main
ways:•Melaena = Black motions/stool•Haematemesis = Vomiting blood
• Other symptoms:• Anaemia• Syncope• Fatigue
Clinical Indicator Probability of Upper GI Source
Haematemesis Almost certain
Melena Probable
Haematochezia Possible
Blood-streaked stool
Rare
Melaena• Melaena comes from the Greek melas meaning black
• Has a characteristic smell of “altered blood”
• Tar-like in presentation• Colour is a result of iron oxidation as
blood moves through ileum and colon
Haematemesis• Bloody vomitus• Bright red/frank blood• “Coffee-ground” vomitus
–Haem exposed to stomach acid for some time–Oxidises– Takes on dark colour
Causes of Upper GI bleeds• Common causes:
• Mallory Weiss tear• Oesophagitis• Oesophageal varices• Peptic Ulcers – gastric and duodenal ulcers• Gastritis/gastric erosions• Duodenitis• Malignancy• Drugs – NSAIDS, aspirin, steroids,
thrombolytics, anticoagulants• Ideopathic
•Mallory-Weiss tear = Tear in mucosal layer at junction between oesophagus and stomach•Often as a result of prolonged + forceful vomiting
Oesophagitis
Oesophageal varices
Duodenal ulcer seen via endoscopy
Gastric ulcer
PEPTIC ULCERS
•Severe Gastrits•Erosive gastritis on contrast radiograph
•Duodenitis
Causes of Upper GI Bleeds• Rare causes:
• Bleeding disorders (eg Haemophilia)• Portal hypertensive gastropathy• Aortoenteric fistula• Angiodysplasia• Haemobilia• Dieulafoy lesion• Meckel’s diverticulum• Peutz-Jegher syndrome• Osler-Weber-Rendu syndrome
Portal hypertensive gastropathy
Aortoenteric fistula
Angiodysplasia
Dieulafoy lesion
Meckel’s diverticulum
Osler-Weber-Rendu syndrome
Management• In medical emergency:
» Protect airway» IV line for fluids + cross match blood» Monitor urine output» Correct clotting abnormalities» Monitor pulse, BP, CVP» Inform surgeons of all severe bleeds
• Post-emergency:» Locate + diagnose source of bleed , eg
endoscopy» Stop bleed, eg surgery, electrocautery, laser
therapy, adrenaline, banding, clipping