Gastrointestinal bleed overview

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Information about Gastrointestinal bleed overview
Health & Medicine

Published on April 27, 2014

Author: shybinusman

Source: slideshare.net

Description

An overview for GI bleed for MBBS level

GI BLEED

DEFINITIONS  Haemetemesis – Vomiting fresh/altered blood  Melena – Altered blood in faeces  Hematochezia – Fresh blood/clots per rectum  Faecal occult blood – Not visible, detected by lab tests for RBC degradation products  Obscure Bleeding – GI blood loss, unknown origin, recurs/persists after intial neg endoscopic eval.

SYMPTOMS  Acute bleed – upper/lower  Fatigue, weakness, abd pain, pallor  Hypotension, hypovolemic shock

CAUSES UPPER GI  Peptic ulcer  Gastric or esophageal varix  Esophagitis  Upper gastrointestinal tract tumor  Angioma  Mallory-Weiss tear  Erosions  Dieulafoy’s lesion  Other

CAUSES LOWER GI  Diverticulosis  Colon cancer or polyps  Colitis (Noninfectious & Infectious)  Ischemic colitis  IBD  Angioectasia  Postpolypectomy  Rectal ulcer  Hemorrhoids  Anorectal source  Radiation colitis  Other  Unknown

SCORING SYSTEM  Rockall scoring for upper GI (0-11)  Parameters:-  Age  Pulse rate  Systolic BP  Comorbidity  Endoscopic Dx  Endoscopic stigmata of recent bleed  <3=Good, >8=Very bad

SCORING ALTERNATE  Glasgow – Blatchford:-  Whom to Rx as OP

MANAGEMENT  Stabilize the patient  Stop the bleeding  Find the source of bleeding  Prevent recurrence of bleeding

IMMEDIATE  Assess clinical status  PR, BP, RR, Conciousness  Large bore IV access – 2  Stabilize haemodynamics  IV fluids, PRBC, Whole blood  Vasopressors  NG aspirate – Large bleeds, doubtful bleeds

LAB TESTS  Complete blood counts  Hb, TC, DC, ESR  Coag profile  PT, INR, APTT, Platelet count  Blood group, cross-match  LFT  RFT

SPECIAL INVESTIGATIONS  Tagged RBC scintigraphy  Arteriography

HISTORY & EXAMINATION  Drugs – OAC, NSAID, Aspirin, Doxycycline  Alcohol, Chronic Liver Disease  Coagulation disorders  Retching  Carcinoma, Polyps  Radiation, Surgery (abd, aortic)  H/o embolism

EXTRAS  Stop anticoagulants  FFP  Vit K  Protamine (for heparin)  Platelet conc – for low platelet count  Enema, prokinetics  ETT – Unconscious, severe bleed

SPECIALS  Non-variceal – PPI  Variceal -  Octreotide (synthetic Somatostatin)  Vasopressin  CLD - Cephalosporins

INTERVENTIONS  Endoscopy :-  Diagnostic  Therapeutic – Ligation, Banding, Clipping, Sclero  Sengstaken-Blakemore tube :-  Variceal bleed  Embolisation of bleeding artery

SURGICAL OPTION  Indication:-  Haemodynamic instability  Clinical deterioration  >6 units of transfusion  Persistent/Recurrent bleed

SURGERY - HOW  Excision  Under-running sutures  Ligation of artery  TIPSS  Splenectomy

OBSCURE TYPE  Headache for gastroenterologist  Capsule endoscopy  Exploratory laparotomy

PROPHYLAXIS  Peptic ulcer –  PPI  H.Pylori eradication  Variceal –  Β blockers  TIPSS  Splenectomy

And that is it for now

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