1 / 34

UPPER GI BLEEDING

UPPER GI BLEEDING. Busara Charoenwat , MD. Pediatric Gastroenterology and Hepatology Department of Pediatric, KKU. Upper GI Bleeding. Epidemiology. Pediatric Endoscopy Database System - Clinical Outcomes Research Intensive (PEDS-CORI) 5 % hematemesis (327 from 6337 patients) PICU

dfogle
Télécharger la présentation

UPPER GI BLEEDING

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. UPPER GI BLEEDING BusaraCharoenwat, MD. Pediatric Gastroenterology and Hepatology Department of Pediatric, KKU

  2. Upper GI Bleeding

  3. Epidemiology • Pediatric Endoscopy Database System - Clinical Outcomes ResearchIntensive (PEDS-CORI) • 5 % hematemesis (327 from 6337patients) • PICU • 6-25 % hematemesis • Mortality rate 0.4% • Bancroft J, et al. gastrointest endosoc 2003;57:AB121. • Chaibou M, et al. Pediatrics 1998;102:933-8. • Cochran EB et al. Crit Care Med 1992;20:1519-23.

  4. Is it blood? Is it blood? Is the bleeding GI? Nasopharynx Respiratory (hemoptysis) GI • Red color food • Tomato, strawberry, spinach, beetroot, iron

  5. GI bleeding site UGIB/ LGIB UGIB/ MGIB/ LGIB UGIB UGIB MGIB LGIB Ligament of Triez LGIB • สุพจน์ นิ่มอนงค์. Classification of gastrointestinal bleeding. • เลือดออดในทางเดินอาหาร 2553. หน้า 1-3.

  6. GI bleeding site

  7. Modalities EGD Colonoscopy Capsule enteroscopy

  8. Characteristics of the bleeding Hematemesis Coffee ground Melena Hematochezia

  9. Etiology of UGIB by age group • Gilger M, Whitfield K. Upper gastrointestinal bleeding. • Walker's Pediatric Gastrointestinal Disease: 5th ed; 2008. p. 1285-90. • Romano C, et al. World J Gastroenterol 2017;23:1328-37.

  10. UGIB: esophagus • (A) (B) (C) • Reflux esophagitis Esophageal varices Candida esophagitis

  11. UGIB: stomach (F) H.pylori infection (D) Stress gastritis (E) Gastric varices (G) Fundic gland polyp

  12. UGIB: duodenum (H) Duodenitis/ duodenal ulcer

  13. UGIB: others (I) (J) (K) Dieulafoy lesion Gastric Crohn’s disease hemangioma

  14. Diagnosis Varices Non-varices Extrahepatic Intrahepatic Pre-sinusoid Sinusoid Post-sinusoid Swallowed maternal blood CMPA Esophagitis Gastritis Biecker E. World J Gastroenterol 2013;19:5035-50.

  15. Portal hypertension Wyllie R. et al, Pediatric Gastrointestinal and Liver Disease. 2015;9:928-43.

  16. Variceal bleeding Signs of portal hypertension

  17. Non-variceal bleeding Romano C, et al. World J Gastroenterol 2017;23:1328-37.

  18. Management • Supportive treatment • Specific treatment • Variceal bleeding • Non - variceal bleeding

  19. Supportive treatment • Airway, Breathing, Circulation • Volumn status • NG/ SBBT • Blood components (keep Hb 7-8 g/dL) • Correct coagulopathy

  20. Specific treatment • Romano C, et al. World J Gastroenterol 2017;23:1328-37. • Laine L. N Engl J Med 2016;374:2367-76. • Bozic MA , et al. Curr Gastroenterol Rep 2015;17:1-8.

  21. Acid secretion

  22. Transjugular intrahepatic portosystemic shunt (TIPS)

  23. Need for endoscopy? Thomson MA, et al. JPGN 2015;60: 632–36

  24. Sheffield Scoring System Thomson MA, et al. JPGN 2015;60: 632–36.

  25. ESPGHAN guideline Thomson MA, et al. JPGN 2017;64: 133–53.

  26. ESPGHAN guideline Thomson MA, et al. JPGN 2017;64: 133–53.

  27. ESPGHAN guideline ESPGHAN guideline Thomson MA, et al. JPGN 2017;64: 133–53.

  28. ESPGHAN guideline Thomson MA, et al. JPGN 2017;64: 133–53.

  29. EVS/ EVL EVS/ EVL EVS EVL Pre - EVS Post - EVS Pre - EVL Post - EVL

  30. Mechanical device Hemoclips Thermocoagulation

  31. Prophylaxis

  32. Meso-Rex bypass shunt Shneider BL, et al. Hepatology 2016;63:1368-80.

  33. Take home messages • Required prompt attention • Recognition • Always remember: ABCD • Required urgent co-operation • Doctors management • Nursing care • Laboratory investigations • Supportive/ specific treatment

  34. Thank you!

More Related