Presentation on theme: "UPPER GI BLEEDS. Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno- jejunal flexture. Definition."— Presentation transcript:
Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno- jejunal flexture. Definition Haematemesis or Malaena Abdo pain, hypotension (fatigue etc), purpura, liver pathology stigmata (spleno-hepato- megaly, spider naevi, jaundice, hepatic flap
Rx – Upper Bleeds Resuscitate/ABC - hypovolemia: Rapid history and examination, note age. Monitor pulse and BP every 30 mins Take blood for haemoglobin, urea, electrolytes and grouping; Establish IV access Give blood transfusion/colloid if necessary Indications: 1. If in shock: BP 100bpm 2.haemoglobin<10g/dL Oxygen therapy for shocked patients
Correct any clotting abnormalities – Vit K? Warfarin? Vasopressin PPI Urgent Endoscopy – adrenaline /banding (arrests bleeding)
Definition The loss of blood from the GI tract distal to the ligament of Trietz. This is the anatomical marker for the junction between the duodenum and the jejunum.
Causes Causes of lower GI haemorrhage in adults Percentage of pts Diverticular disease -Diverticulosis/diverticulitis of small intestine -Diverticulosis/diverticulitis of colon 60% IBD -Crohn's disease of small bowel, colon, or both -Ulcerative colitis -Noninfectious gastroenteritis and colitis 13% Benign anorectal diseases -Hemorrhoids -Anal fissures -Anal fistulas 11% Neoplasia -Malignant neoplasia of small intestine -Malignant neoplasia of colon, rectum, and anus 9% Coagulopathy4% Arteriovenous malformations (AVM)3% TOTAL100% Meckel diverticulum, intussusception, polyposis syndromes, and IBD are the common causes of GI bleeding in children and adolescents
Signs and Symptoms Maroon/red stained stools (hematochezia) or bright red blood from the rectum. Malaena may also occur but it points more towards upper GI bleeds. Hypotension; tachycardia Pallour, weakness, fainting and other signs of anaemia (if chronic) Perform History and ask about IBD, weight loss, FHx of Ca, stomach pain, bleeding disorders, last period.
Rx – Lower Bleeds Resuscitation and initial assessment – same as in upper GIT bleeding Localization of the bleeding site – using investigations such as rectal examination, proctoscopy, sigmoidoscopy, colonoscopy, etc) Therapeutic intervention to stop bleeding at the site. Rx Anaemia
H. Pylori and PUD 95 % DU assoc. With H. Pylori; 80% GU; 4:1 Risks: Smoking, NSAIDs, aspirin, steroids, increased acid secretion, increased gastric emptying, stress???, AGE (x>80) Gram –ve, burrows into mucoid lining; Dx: 13 C Urea breath test Serological tests – IgG antibodies – 80% sensitive & specific Endoscopy: Rapid urease test gastric biopsies added to urea soln. with phenol red. If present ph inc. ↑ & causes colour change Culture biopsies cultured on special medium with antibiotic sensitivities.