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Understanding G.I. Bleeding Causes & Management

This document discusses gastrointestinal (GI) bleeding, including: 1. It distinguishes between acute vs chronic GI bleeding and describes acute upper and lower GI bleeding. 2. For acute upper GI bleeding, the most common causes are drugs like aspirin and NSAIDs, alcohol, and peptic ulcers. Clinical signs include hematemesis and melena. 3. Management of acute upper GI bleeding involves monitoring vital signs, blood tests, IV fluids, blood transfusions, and urgent endoscopy. Endoscopy is also used to control the source of bleeding such as varices or ulcers.

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63 views15 pages

Understanding G.I. Bleeding Causes & Management

This document discusses gastrointestinal (GI) bleeding, including: 1. It distinguishes between acute vs chronic GI bleeding and describes acute upper and lower GI bleeding. 2. For acute upper GI bleeding, the most common causes are drugs like aspirin and NSAIDs, alcohol, and peptic ulcers. Clinical signs include hematemesis and melena. 3. Management of acute upper GI bleeding involves monitoring vital signs, blood tests, IV fluids, blood transfusions, and urgent endoscopy. Endoscopy is also used to control the source of bleeding such as varices or ulcers.

Uploaded by

mkafabillah
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

G.I.

Bleeding

dr. Diah Ari Safitri, SpPD


G.I. Bleeding

 Acute Vs Chronic

 Acute Upper G.I.Bleeding

 Acute Lower G.I.Bleeding


Acute Upper G.I. Bleeding

 Haematemesis

 Melaena
Acute U.G.I. Bleeding

Aetiology
 Drugs (Aspirin & NSAIDs)
 Alcohol
 Chronic peptic ulceration
– (50% of GI hemorrhage)
 Others:
– reflux esophagitis,
– varices,
– gastric carcinoma,
– acute gastric ulcers & erosions.
Acute U.G.I. Bleeding

Clinical approach
 recent (24 hrs)
 if small amount, no immediate Tx,
– CVS can compensate
 85% stop bleeding during 48 hrs
 history helps in diagnosing the cause
of the hemorrhage,
 factors include:
 age (60 +)
 amount of blood lost
 continuing visible blood loss.
 signs of chronic liver disease
 classical clinical features of shock
Acute U.G.I. Bleeding
Immediate management

Emergency management:
 History + exam
 Monitor: pulse & BP /30 min
 Bld sample: Hb, urea, electrolytes, grouping &
cross-matching
 I.v. access
 Bld transfusion in case of
– shock
– Hb <10 g/dl
 Urgent endoscopy
 Surgery when recommended
Shock management: ABC

 Airway
 endotracheal tube, oropharyngeal airway.
 Give oxygen
 Breathing
 support respiratory function
 Monitor: resp. rate, bld gases, chest radiograph
• Circulation
• expand circulating volume: blood, colloids, crystalloids
Monitor: skin color, peripheral temp., urine flow, BP, ECG
Acute U.G.I Bleeding
General Investigations

1. Hb
2. CBC
3. Bld glucose
4. Platelets, coagulation
5. Urea, creatinine, electrolytes
6. Liver biochem.
7. Acid-base state
8. Imaging: chest & abd. radiography,
US, CT
Acute U.G.I. Bleeding

General management:

Blood volume
1. restore volume to normal
2. transfusion

Endoscopy
1. shock, suspected liver disease or
continued bleeding
2. control varices or ulcers to reduce
re-bleeding
Drug therapy
1. H2 – receptor antagonists
2. proton pump inhibitors

Factors in reassessment
1. age: 60 +  greater mortality
2. recurrent hemorrhage: +++ mortality
3. re-bleeding: mostly within the 1st 48 hrs
4. surgical procedures in case of severe
bleeding.
Lower gastrointestinal
haemorrhage

 Causes
• Angiodysplasia
• Diverticular disease
• Inflammatory bowel disease
• Ischaemic colitis
• Infective colitis
• Colorectal carcinoma
Lower gastrointestinal haemorrhage

Investigation

• Most patients are stable and can be


investigated once bleeding has stopped
• In the actively bleeding patient consider
• Colonoscopy - can be difficult
• Selective mesenteric angiography
• Requires continued bleeding of >1 ml/minute
• May show angiodysplastic lesions even once
bleeding has ceased
•Radionuclide scanning
•Uses technetium-99m labeled red blood cells
Management
• Acute bleeding tends to be self limiting
• Consider selective mesenteric embolisation if life
threatening haemorrhage
• If bleeding persists perform endoscopy to exclude
upper GI cause
• Proceed to laparotomy and consider on-table lavage
an panendoscopy
• If right-sided angiodysplasia perform a right
hemicolectomy
• If bleeding diverticular disease perform a sigmoid
colectomy
• If source of colonic bleeding unclear perform a
subtotal colectomy and end-ileostomy

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