Presentation on theme: "GASTROINTESTINAL BLEEDING"— Presentation transcript:
1 GASTROINTESTINAL BLEEDING Part 1Stephanie Faith C. Bautista
2 DEFINITION of Gastrointestinal (GI) Bleeding refers to any bleeding that starts in the gastrointestinal tract, which extends from the mouth to the anus.can occur from abnormal blood clottingcan be caused by vitamin K deficiencies and thrombocytopenia — a drop in platelets (the blood cells that normally initiate the clotting process).The amount of bleeding can range from nearly undetectable to acute, massive, and life threatening.
3 SITEDivided into:Upper GI bleeding: The upper GI tract is located between the mouth and the upper part of the small intestine.Lower GI bleeding: The lower GI tract is located between the upper part of the small intestine and the anus. The lower GI tract includes the small and large bowels.
4 CONSIDERATIONScan range from microscopic bleeding and massive bleedingimportant to be aware, because it may point to many significant diseases and conditions.Prolonged microscopic bleeding can lead to loss of iron, causing anemia.Acute, massive bleeding can lead to hypovolemic shock, and even death.can occur at any age from birth on.the degree and suspected location of the bleeding determines what tests should be performed to find the cause.once a bleeding site is identified, many therapies are available to stop the bleeding.
5 COMMON CAUSES Some of the possible causes of GI bleeding include: Anal FissureGastric (stomach) ulcerAorto-enteric fistulaHemorrhoidsArterio-venous malformations (angiodysplasias)Bleeding diverticulumIschemic bowelIntestinal polypsCancer of the small intestineIntestinal obstruction (twisted bowel)Celiac sprueIntestinal vasculitisColon cancerIntussusceptionCow's milk allergyMallory-Weiss tearCrohn’s diseaseMeckel’s diverticulumDieulafoy's lesionNosebleedDuodenal ulcerPortal hypertensive gastropathyDysenteryRadiation injury to the bowel(infectious diarrhea that causes bleeding)Ruptured appendicitisEsophageal varicesStomach cancerEsophagitisUlcerative colitis
6 Upper Gastrointestinal Bleeding Upper GI bleeding originates in the first part of the GI tract - the esophagus, stomach, or duodenum (first part of the intestine).Upper GI bleeding is caused by one of the following:Peptic ulcersGastritisEsophageal varicesMallory-Weiss tears
7 Lower Gastrointestinal Bleeding Lower GI bleeding originates in the portions of the GI tract farther down the digestive system-the segment of the small intestine farther from the stomach, large intestine, rectum, and anus.Lower GI bleeding is caused by one of the following:Diverticular diseaseAngiodysplasiaPolypsHemorrhoidsAnal fissuresBlood in the stool can result from cancers, inflammatory bowel disease, and infectious diarrhea.
8 SYMPTOMSAcute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black, tarry stools. Blood may look like "coffee grounds."Symptoms associated with blood loss can include the following:FatigueWeaknessShortness of breathAbdominal painPale appearanceVomiting of blood usually originates from an upper GI source.Bright red or maroon stool can be from either a lower GI or an upper GI source.Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or a positive test for microscopic blood.
9 WHEN TO SEEK MEDICAL CARE Call for an appointment with your doctor if:You have black, tarry stools (this may be a sign of upper GI bleeding)You have blood in your stoolYou vomit blood or you vomit material that looks like coffee groundsAny presence of blood in the stool or the upper gastrointestinal tract is significant and needs medical investigation. Black or dark stools may represent slow bleeding into the GI tract and should be investigated by a physician.Any significant bleeding into the GI tract, either vomited blood or blood through the rectum, should be evaluated.
10 What to expect at your health care provider's office: GI bleeding is diagnosed by a doctorGI bleeding can be an emergency condition requiring immediate medical attention.You will also be asked questions about your symptoms, including:When did you first notice symptoms?Did you have black, tarry stools or red blood in the stools?Have you vomited blood?Did you vomit material that looks like coffee grounds?Do you have a history of peptic or duodenal ulcers?Have you ever had symptoms like this before?What other symptoms do you have?
11 EXAMS AND TESTS Tests that may be done include: Abdominal CT scan Abdominal MRI scanAbdominal x-rayAngiographyBleeding scan (tagged red blood cell scan)Capsule endoscopy (camera pill that is swallowed to look at the small intestine)ColonoscopyComplete blood count (CBC)EGD (Esophagogastroduodenoscopy)EnteroscopySigmoidoscopy
12 MEDICAL TREATMENT FOLLOW-UP Serious gastrointestinal bleeding can destabilize your vital signs.The physician may need to resuscitate you with IV fluids and medicine through a veinBlood transfusionsIn some cases, you may need surgery.Tube through the mouth into the stomach to drain the stomach contents (gastric lavage)Once the condition is stable, a physical examination, including a detailed abdominal examination, will be performed.FOLLOW-UPMaintain a proper diet and take the medications prescribed to you as your doctor directs.Follow up with your physician on a regular basis to monitor progress, so that your doctor can prevent further progression and complications of your gastrointestinal bleeding.
13 TREATMENTEarly endoscopy is recommended, both as a diagnostic and therapeutic approach, as endoscopic treatment can be performed through the endoscope.Patients with esophageal varices typically have coagulopathy, plasma products may have to be administered. Vitals signs are continuously monitored.Endoscopic Therapy depends on the lesion identifies, and can include:Injection of adrenaline or other sclerotherapyElectrocauteryEndoscopic clipping orBanding of varicesBleeding lesion are usually removed in order to determine the underlying pathology, and to determine the risk for rebleeding.
14 PHARMACOTHERAPYIncludes the following:Proton pump inhibitors (PPIs) - reduce gastric acid production and accelerate healing of certain gastric, duodenal and esophageal sources of hemorrhage. Administered orally / intravenouslyOctreotide is a somatostatin - shunt blood away from the splanchnic circulation. Found to be a useful in management of both variceal and non-variceal upper GI hemorrhage.Terlipressin is a vasopressin - most commonly used for variceal upper GI hemorrhage.Antibiotics are prescribed in upper GI bleeds - associated with portal hypertensionIf Helicobacter pylori is identified as a contributant to the source of hemorrhage, then therapy with antibiotics and a PPI is suggested.
15 PREVENTION You can prevent some causes of gastrointestinal bleeding. Avoid foods and factors, such as alcohol and smoking, that increase gastric secretions.Eat a high-fiber diet to increase the bulk of the stool, which helps prevent diverticulosis and hemorrhoids.
17 Upper gastrointestinal bleeding. Ulcer with a clean base.
18 Upper gastrointestinal bleeding Ulcer with a black spotUlcer with an overlying clot
19 Upper gastrointestinal bleeding. Ulcer with a visible vessel.
20 Upper gastrointestinal bleeding. Ulcer with active bleeding
21 Intussusception - x-ray: Abdominal x-ray showing an intestinal condition in which a loop of bowel has slipped into another section of bowel called INTUSSUSCEPTION.causing swelling, reduced blood flow, obstruction, and tissue damage.Intussusception requires emergency treatment (barium enema or surgery) to prevent intestinal tissue death (necrosis), intestinal perforation, peritonitis, and death.
22 Patient with a twisted bowel (volvulus). Volvulus - x-ray:Patient with a twisted bowel (volvulus).
23 Normal anatomy:The Gastrointestinal Tract starts at the mouth, which leads to the esophagus, stomach, small intestine, colon, & finally, the rectum and anus.The GI tract is a long, hollow, muscular tube through which food passes & nutrients are absorbed.
24 Indication: Bleeding from the GI tract is a common medical problem. Patients usually notice either dark red blood or bright red blood in their stool.Ulcers of the stomach and duodenum are common causes of bleeding from the upper GI tract.Bleeding can also occur in the lower GI tract (colon).Diverticular bleeding is a common cause of lower GI bleeding.
25 ENDOSCOPY Procedure, part 1 The first step in the treatment of GI bleeding is to locate the source of the bleeding. Patients who have lost significant amounts of blood are transfused with blood.Next, an endoscopy is used to locate the source of the bleeding. Upper endoscopy is generally performed first, and if no bleeding source is located, then lower endoscopy is performed. During an endoscopy, the patient is usually sedated but awake.
26 Procedure, part 2In many cases, GI bleeding will stop on its own, with no treatment.In other cases, treatment can be provided with the endoscope, most often in the form of cautery (electrocoagulation) of the site of bleeding.
27 Procedure, part 3:If the bleeding cannot be stopped using the endoscope, surgery may be required. The bleeding segment of intestine or stomach is removed. However, most cases of GI bleeding are managed succesfully with endsocopy.
30 UPPER GASTROINTESTINAL BLEEDING Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage.
31 Gastric ulcer in antrum of stomach with overlying clot Gastric ulcer in antrum of stomach with overlying clot. Pathology was consistent with gastric lymphoma.
32 Endoscopic image of small gastric ulcer with visible vessel Same ulcer seen after endoscopic clipping
33 Mallory-Weiss Syndrome 34-year-old male physician who had been ingesting alcoholic beverages, presented with bleeding of the g.i. tract.43-year-old male who presented with vomiting after ingestion of alcoholic beverages. Also note the signs of reflux esophagitis as well as a blood clot from a gastro esophageal tear.
48 Exact site of the bleeding of acute variceal bleeding Endoscopy is an essential step in the diagnosis and treatment of acute variceal bleeding
49 Endoscopic Variceal Ligation (Banding) ENDOSCOPIC VARICEAL LIGATION is like rubber-band ligation of hemorrhoidsEsophageal mucosa and submucosa containing varices are ensnared, causing subsequent strangulation, sloughing, and eventual fibrosis, resulting in obliteration of the varices.Endoscopic ligation requires placement of an opaque cylinder over the end of the endoscope. This decreases the endoscopic field of view and may allow pooling of blood. Thus, in patients with active bleeding, visualization may be impaired more with ligation than with sclerotherapy.Local complications are less common with ligation compared to sclerotherapy.