Upper GIT bleeding

Prepared by:

Maryam abdulwahid

Tanya muhammad

Hewar jarjis

Sanaa fuad

Hedi Hamid

Hawrin Muhammad

Rawand Muhammad

• Its considers as medical emergencies.

• Any bleeding above the ligament of treitz is upper

GI bleeding and bellow the ligament of treitz is

lower GI bleeding.

This ligament is anatomic cut-off for upper GI

bleeding that connect the fourth part of duodenum

to the diaphragm near the splenic flexer of colon.

Clinical presentation

Hematamesis (coffee-ground emesis, Gross blood

and clots )

Melena ( black tarry stool and have distintive

odour)

Hematochezia(passage of bright red blood per

rectum)

Patient may also present complication of anemia

including chest pain, syncope, fatigue, shortness

of breath.

dyspepsia, heart burn, epigastric pain, dysphagia,

difuse abd.pain, wt loss……

Risk factors

1. alcohol abuse

2. Non-steroidal anti inflammatory

drugs.

3. Chronic renal failure

4.Age

5.Low socio economic class

Approach

1/Estimate severity of bleeding

2/ localize site of bleeding

3/ Resuscitation

4/ diagnosis

5/ Treatment

Assessment severity

Through history and examination initially

History includes abdominal or epigastric pain , weakness, dizziness, hematamesis, melena and syncope

History of recent drug ingestion (aspirin ,NSAID)

history of PU

EXAMINATION :

the extent of blood loss and signs of shock !!

By Pulse and blood pressure

pallor and signs of anamia

postural hypotension

Other signs of shock :

Cool extremities

Chest pain

Confusion

Delirium

Also evidence of dehydration

And urine output should be monitored

Resuscitation

Cannula

NG tube

Foley catheter

Blood sample

N/S

Transfer blood if:

Correct bleeding disorders

Iced normal saline.

Peptic ulcer

Peptic ulcer includes both duodenal ulcer and gastric ulcer

Incidence of gastric ulcer is equal in both male and female

but the population tend to be older

Incidence of duodenal ulcer is higher in males than in

females.

How to suspect PU ?

The signs and symptoms are suggestive of PU but the

definitive diagnosis of PU is by endoscopy

Common sites of peptic ulcer

First part of duodenum

Lesser curvature of the stomach

Etiology of peptic ulcer

high gastric acid level

helicobacter pylori

gastrinoma (zollinger-ellison syndrome)

NSAID

social stress, smoking and genetic factors

malignancy

Sites of the bleeding ulcer

- DU they tend to erode posteriorly causing

bleeding of gastroduodenal artery

- Left gastric artery is involved in 85% bleeding

sometimes is from splenic artery

precaution should be taken when a gastric

ulcer is seen

Diagnosis

-OGD is both diagnostic and therapeutic for PU,

early endoscopy allows estimation of the rate of

recurrent bleeding and enables various therapeutic

options.

-Barium contrast can also be used for diagnosis

Treatment

Anti-acids; h2 receptor antagonists (cimetidine and

ranitidine…) and PPI (omeprazole, pantoprazol,… )

Endoscopic electrocoagulation

Angiographic embolization

Surgery

-patient with a visible vessel on the ulcer base

-a spurting vessel

-an ulcer with clot in the base

Esophageal varices

esophageal varices are enlarged veins in the walls of the

lower part of the esophagus.

10% of UGIT bleeding

30% mortality rate

symptoms may include:

melena

hematoschezia

Light-headedness

Paleness

Symptoms of chronic liver disease

Vomiting

hematemesis

Treatment

Vasoactive drugs…terlipressin, or somatostatin

Endoscopy/Band ligation is the first choice of treatment.

Emergency sclerotherapy is still widely used as a first-line

therapy for variceal bleeding in patients with cirrhosis, especially

when band ligation is not available.

Balloon tube tamponade (Sengstaken-Blakemore

tube)

Transjugular intrahepatic portosystemic shunt

Surgery/Oesophageal transection and gastric

devascularisation are rare procedures but may

have a role for patients with portal and splenic vein

thrombosis

Gastritis Gastritis is an inflammation, irritation, or erosion

of the lining of the stomach.

1/3 of UGIT bleeding

Acute/ NSAID, steroid, alcohol & potassium.

Chronic/ H.pylori bacteria.

Rx

Lifestyle changes :

avoid or limit alcohol consumption

avoid spicy, fried, and acidic foods

eat frequent, small meals

reduce stress.

Antacids: H2rb, PPI

Eradication of H.pylori

Vassopressin infusion.

Endoscopic electrocoagulation

Surgery

MALLORY WEISS SYNDROME

A condition characterized by upper gastrointestinal bleeding secondary to longitudinal mucosal lacerations at gastroesophagealjunction.

accounts of about 15% UGIT bleeding .

More common in male than female.

Risk factors: repeated vomiting, alcohol intake, coughing, blunt abdominal trauma, hiatal hernia.

Presentation:

hematemesis

melena

hematochezia

abdominal pain

Diagnosis:Esophagogastric duodenoscopy ( by active bleeding, clot , fibrin crust over mucosa within or near gastroesophageal junction).

Treatment:_may stop spontaneously.

Endoscopic therapy: coagulation and epinephrine injection Angiotherapy: Elective vasopressin infusion or embolization of the left gastric artery.

Surgery

Thank you