1. O. N. M. Panton, MB, BS, FRCSC, FACS, Head, UBC Division of General Surgery, VGH/UBCH

3.  HAEMORRHAGE  SEPSIS

4.  Upper GI  Small Bowel  Colorectal  Solid organ

5.  Gastric or duodenal ulcer  Varices  Mallory-Weiss tear  Oesophageal ulcer

6.  Varices  Mallory-Weiss tear  Esophagitis/ulcer – acid reflux, infection  Neoplasia  Trauma

9.  Gastritis  Superficial  Stress ulceration  Mechanical

10.  Gastric Ulcer  Benign or malignant (10%)  Initial biopsy if safe  Repeat OGD to assess healing & repeat bx  Benign: drug-induced, hypersecretors +/- H. pylori infection

11.  Duodenitis  Benign ulcer  Crohn’s  Neoplasia  Vascular Malformation  Dieulafoy

12.  Haemobilia  Aortoduodenal fistula

13.  Benign ulcer  May have all the same etiology as stomach  Major bleeding usually gastroduodenal artery

17.  32 year old male found at home in a pool of blood & still vomiting blood  VGH ER pulse140 BP 60/0  Hb 32  Massive resuscitation/transfusion protocol  Codes x 2 in ER  OGD bleeding ++++

18.  OR STAT laparotomy  Codes shortly after laparotomy  Duodenotomy/gastrotomy  Watermelon stomach torrential haemorrhage  Blood gushing from duodenum  Died on table

19.  Angiodysplasia  Diverticular disease  Neoplasia: Adenocarcinoma, GIST’s  Ischemia  Hemmorhoids  IBD  Infection: Campylobacter, Shigella, Salmonella, Enteropathogenic E. coli

20.  Acute bleeding occurs in 20-30 cases/100,000 annually  20-30% of GI bleeds

27.  67 year old female found down at home in a pool of blood passed per rectum  VGH ER pulse 156 BP 50/0 Hb 36  Resuscitated/massive transfusion protocol  Previous LAR/TME rectal ca neoadjuvant short course radiorx  Leak/Hartmann

28.  STAT OR  Pre-sacral ulcer communicating with rectal stump  Packed/controlled  ICU plan for IR angio/embolization  DIC ICU & died

29.  56 year old male presents VGH ER sudden (R) flank pain  Pulse 148 BP 210/110 Hb 88  Resuscitated then STAT laparotomy  (R) suprarenal ruptured tumour

31.  Perforated appendicitis  Colonic perforations  Gasrtro-duonenal perforations  Mesenteric ischaemia with infarcted gut  Gangrenous cholecystitis  Necrotizing pancreatitis  Ascending cholangitis

35.  47 male HIV + 24 hour hx severe abdominal pain  CT dx terminal ileitis Rx IV antibiotics  GS consulted next night  Temp 39 pulse 120 BP 115/68  Generalized peritonitis WBC 18 creatinine 110- 169

36.  DL RLQ abscess  Laparotomy: gangrenous appendicitis/faecolith  Appendectomy & drainage of abscess