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Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding can occur due to peptic ulcers, esophageal varices, or other sources. Peptic ulcers are the most common cause, occurring in the stomach or duodenum. H. pylori infection and NSAID use are the primary causes of peptic ulcers. Treatment involves eradicating H. pylori if present, discontinuing NSAIDs if possible, and using PPIs long-term to prevent bleeding recurrence.

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215 views7 pages

Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding can occur due to peptic ulcers, esophageal varices, or other sources. Peptic ulcers are the most common cause, occurring in the stomach or duodenum. H. pylori infection and NSAID use are the primary causes of peptic ulcers. Treatment involves eradicating H. pylori if present, discontinuing NSAIDs if possible, and using PPIs long-term to prevent bleeding recurrence.

Uploaded by

iron
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Upper Gastrointestinal

Bleeding
Gastrointestinal Bleeding
1. Hematemesis - vomitus of red blood or "coffee-
grounds" material.
2. Melena - black, tarry, foul-smelling stool.
3. Hematochezia - the passage of bright red or maroon
blood from the rectum.
4. Occult GI bleeding (GIB) may be identified in the
absence of overt bleeding by a fecal occult blood test
or the presence of iron deficiency.
5. Symptoms of blood loss or anemia such as
lightheadedness, syncope, angina, or dyspnea.
Upper Gastrointestinal Sources of
Bleeding
Sources of Bleeding Proportion of Patients
Ulcer 31-59%
Varices 720 %

Mallory-Weiss tears 48%

Gastroduodenal erosions 27%


Erosive esophagitis 113%
Neoplasm 27%
Vascular ectasias 06%
No source identified 814%
Peptic Ulcer Disease
Burning epigastric pain exacerbated by fasting and
improved with meals is a symptom complex associated
with peptic ulcer disease
Ulcer is defined as disruption of the mucosal integrity of
the stomach and/or duodenum leading to a local defect
or excavation due to active inflammation
occur within the stomach and/or duodenum and are
often chronic in nature
Gastrointestinal bleeding is the most common
complication observed in PUD
Peptic Ulcer
Peptic ulcers are ulcers that form in the stomach or
duodenum
Gastric ulcer - an ulcer in the stomach
Duodenal ulcer - ulcer in the duodenum

Both a gastric ulcer and a duodenal ulcer result when H.


pylori or a drug weakens the protective mucous coating
of the stomach and duodenum, allowing acid to get
through to the sensitive lining beneath. Both the acid
and the bacteria can irritate the lining and cause an
ulcer to form.
Cause of peptic ulcer
Helicobacter pylori
NSAIDs
Eradication of H. pylori in patients with bleeding
ulcers decreases rates of rebleeding to <5%.
If a bleeding ulcer develops in a patient taking
NSAIDs, the NSAIDs should be discontinued, if
possible. If NSAIDs must be continued, initial
treatment should be with a PPI
Treatment
Long-term preventive strategies to decrease NSAID-
associated ulcers include use of a cyclooxygenase 2
(COX-2) selective inhibitor (coxib) or addition of GI co-
therapy to a traditional NSAID
PPIs and misoprostol are effective co-therapies, but PPIs
are more commonly used due to less frequent dosing
(once daily)
Patients with bleeding ulcers unrelated to H. pylori or
NSAIDs should remain on full-dose antisecretory therapy
indefinitely

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