Presentation on theme: "UPPER GASTROINTESTINAL BLEEDING What Undergraduates should know ?"— Presentation transcript:
1UPPER GASTROINTESTINAL BLEEDING What Undergraduates should know ? Prof SM ChandramohanProf and HODDepartment of Surgical Gastroenterology andCenter of Excellence for Upper GI SurgeryMadras Medical College andRajiv Gandhi Government General HospitalChennai
2Can download this presentation from www.esoindia.org Prof SM ChandramohanProf and HODDepartment of Surgical Gastroenterology andCenter of Excellence for Upper GI SurgeryMadras Medical College andRajiv Gandhi Government General HospitalChennai
6DEFINITION CAUSES EVALUATION TREATMENT PLAN OF THE TALKCAUSESEVALUATIONTREATMENT
7DEFINITION CAUSES EVALUATION TREATMENT PLAN OF THE TALKCAUSESMEDICALENDOSCOPICSURGICALEVALUATIONTREATMENT
8DEFINITION Any bleeding from The gastrointestinal Tract above the Level ofligament of Treitzis upper GI Bleeding
9DEFINITIONS Acute GI bleed Overt vs. occult < 3 days duration hemodynamic instabilityrequires blood transfusionOvert vs. occultovert = visible blood (melena, bright red blood, coffee grounds)occult = only detected by lab tests
11COMMON CAUSES OF UGI BLEED %Peptic Ulcer38%Varix16%Tumor7%MW Tear4%ErosionsEsophagitis13%
12NSAID(1) the risk of gastric ulceration is increased to a greater extent than that of duodenal ulceration(2) the risk of bleeding varies with the individual NSAID; for example, the relative risk of bleeding is greatest with piroxicam and less with ibuprofen(3) the risk of bleeding is dose dependent-age greater than 75 years,-history of heart disease,-history of peptic ulcer- history of previous gastrointestinal bleedingRISK FACTORS
51SECOND LOOK ENDOSCOPY It is repeat endoscopy 24 hours after initial Endoscopic hemostasisINDICATIONS1 Incomplete first endoscopic examination dueto blood obscuring the field2 Patients with clinically significant rebleeding
60Managed with 1 Hemoclips 2 MPEC Probes 3 PPI MALLORY WEISS TEARSManaged with1 Hemoclips2 MPEC Probes3 PPI
61Mallory-Weiss TearsAngiographic embolization – in cases of failed endoscopic therapyHigh gastrotomy and suturing of the mucosal tear – failure of all methodes
62DIEULAFOY’S LESION large submucosal artery that protrudes through mucosaat the gastric fundus.bleeding can be massiveEndoscopic Doppler USG canhelp localizeEndoscopic hemostasis -injection therapy , Thermal probe, clips.
64DIEULAFOY'S LESIONFailed endoscopic therapy - angiographic coil embolizationSurgical intervention - prior endoscopic tattooingGastrotomy - bleeding source can be oversewnPartial gastrectomy - the bleeding point not identified
65GASTRIC ANTRAL VASCULAR ECTASIA-GAVE rows of ectatic mucosalVessels(WATERMELON STOMACH)most patients present with persistent, iron deficiency anemia from continued occult blood loss.It is managed with1 APC-argon Plasma coagulation2 MPECMultiple sessions may be needed to eradicatethe lesions.
69Gastric Antral Vascular Ectasia Endoscopic therapy - successful in up to 90% of patientsFailure of endoscopic therapy - antrectomy
70SEVERE PORTAL HYPERTENSIVE GASTROPATHY May present with acute orchronic bleed.No role for endoscopicmanagement.Managed with B Blockers, TIPS,Surgical Porto Caval shunt,Liver transplantation.
71HEMOBILIA The diagnosis can be confirmed By Side viewing Scopy Ongoing or Recurrent bleed isTreated with angioembolizationCAUSES-HEMOBILIALiver traumaLiver biopsyERCP/PTC/TIPSHCC, CHOLANGIOCARCINOMABiliary parasite infestations
72HEMOSUCCUS PANCREATICUS The diagnosis can be madeby Side viewing scopyManagement is byangioembolizationCAUSES-HEMOSUCCUS PANCREATICUSAcute pancreatitis/chronic pancreatitisPancreatic pseudocystPancreatic cancerERCP manipulation of PDRupture of splenic artery pseudoaneurysm into PD
74STRESS GASTRITIS Surgery - rarely indicated Vagotomy and pyloroplasty, with oversewing of the hemorrhage, or near-total gastrectomy - mortality rates as high as 60%
75MalignancyEndoscopic therapy - successful in controlling hemorrhage, the rebleeding rate is highStandard cancer operations - indicated when possiblePalliative wedge resections – to control bleed
76Aortoenteric Fistula Ligation of the aorta proximal to the graft Removal of the infected prosthesisExtra-anatomic bypassDefect in the duodenum - small and can be repaired primarilyTypically, patients with bleeding from an aortoenteric fistula will present first with a “sentinel bleed.”
77MORTALITY7% to 10%.The mortality has decreased only minimally during the last 30 years, despite the introduction of endoscopic therapy that reduces the rate of rebleeding.increasing percentage of UGIB occurring in the elderlyfrequent use of antiplatelet medications or anticoagulantsfrequent comorbid conditions.