Transcript
Evaluation of Upper Gastrointestinal
Bleed
Anatomy• Upper Gastrointestinal tract is proximal to
ligament of Treitz.
Common causes :Oesophageal : Gastric : Duodeal :
Oesophageal varices Gastric ulcer Ulcer
Oesophagitis Gastric cancers Vascular malformation (Aorto-entric fistulae)
oesophageal cancer Gastritis Hemobilia
Mallory-Weiss tear Gastric varices Hemosuccus pancreaticus
Oesophageal ulcer Portal hypertension gastropathy
Severe superior mesentric artery
syndrome
Gastric Antral Vascular Ectasia (GAVE)
Common causes :
types :
• VARICEAL BLEEDING
• NON VARICEAL BLEEDING
Clinical presentation• Hematemesis
• Melena
• Hematochezia
• Occult GI bleeding
• Anaemia
• Shock
Approach :• Initial assessment and
resuscitation.
• History - Alcoholism, drugs, weight loss, anorexia.
• Physical examination + Signs of liver cell failure
• Investigations• Diagnosis
• Treatment
Clinical presentation
• History
Lab investigations :• CBC- Hb, Platelet count.
• PCV
• Coagulation profile
• Serum electrolytes
• BUN/creatinine ratio ≥ 30
• Blood grouping and cross match
Lab investigations :• ECG
• Stool routine (occult blood)
• HIV, HbsAg, Anti HCV
• RFT
• LFT
• Gastrin levels
Endoscopy• Esophagogastroduodenoscopy (EGD)*
• Video capsule endoscopy
• Push Enteroscopy
• Deep Enteroscopy
• Single/double ballon.
• spiral endoscopy.
radiologic imaging• Mesentric Angiography
• Radionuclide scanning
• CT enterography and CT angiography
treatment• Medical
• Endoscopic
• Balloon tamponade
• surgery
Priority:
Control the Haemorrhage
variceal bleedingEsophageal
• Endoscopic- EVL, EST
• Balloon Tamponade- Sengstaken Blakemore tube
• Surgical- TIPS, Liver transplant
variceal bleedingGastric
• Endoscopic
• Balloon Tamponade- Linton Nachalas tube
• Surgery- TIPS, Liver transplant
non variceal bleedingPeptic Ulcer Disease (PUD)
• Medical.
• Endoscopic
• Angiographic Embolisation.
• Surgery.
modalities for endoscopic therapyInjection Therapy
• Epinephrine• Hypertonic saline• Sclerosant- Absolute alcohol, polidoconol• Tissue adhesive- cyanoacyralate
Thermal Therapy
• Contact- HP, Bipolar• Non Contact- APC, Nd:YAG laser
Mechanical Therapy
• Endoclips• Endoscopic band lgation
Combination Thepary
Thank you
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