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Gastrointestinal Bleeding

Gastrointestinal Bleeding. G Muthukumarasamy Specialist Registrar in General Surgery. Anatomy and Physiology. Oesophagus. Stomach. Duodenum. History taking. Complaints Haematemesis Malena Haemotochezia Pain Light-headedness, syncope, dyspnoea,

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Gastrointestinal Bleeding

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  1. Gastrointestinal Bleeding G Muthukumarasamy Specialist Registrar in General Surgery

  2. Anatomy and Physiology

  3. Oesophagus

  4. Stomach

  5. Duodenum

  6. History taking • Complaints Haematemesis Malena Haemotochezia Pain Light-headedness, syncope, dyspnoea, altered mental status (blood loss symptoms) occult blood loss (anaemia)

  7. Malena and Coffee ground vomiting

  8. Contd., • H/o Drug intake – Aspirin, Anticoagulants (warfarin), NSAIDS, Clopidogrel, steroids • H/o Alcohol intake, smoking • H/o Weight loss Past History : Chronic liver disease, peptic ulcer, bleeding Disorders

  9. Examination • General Examination Mental status Eyes – Pallor, Jaundice Liver disease – caput medusae, spider angiomas, ascites, palmarerythema, flap Bleeding disorders – Petechia, echymosis Vital Signs – BP, HR, SaO2, RR, T⁰, CRF Urine output

  10. Jaundice and Anaemia

  11. Liver disease

  12. Petechiae/Echymosis

  13. Examination – contd., • Abdominal Inspection – Shape, symmetry, Dilated Veins, signs of liver failure Palpation – tenderness, Splenomegaly, hepatomegaly Percussion – Shifting dullness, Fluid thrill Auscultation – BS, Bruit Rectal Examination – Fresh blood, Malena CVS, RS, Neurological Examination

  14. Investigation • FBC, Coagulation profile, U&ES, LFT, CRP, Calcium • Type and Crossmatch Blood • ECG • CXR • OGD • Angiogram CT or Catheter • Nasogastric lavage • USS/CT (to assess liver disease) • Tc-99m-labeled erythrocyte scans (rarely)

  15. Management • RESUSCITATION – ABCDE • Fluid and BLOOD Replacement • Medical Management - PPIs, Vasoactive agents, B-blocker, ISMN (to prevent re-bleeding) • Endoscopic management – Adrenaline, coagulation, banding, clipping • Interventional Angiography – coiling, TIPS • Surgical Management

  16. Haemorrhagic Shock

  17. UpperGI Bleeding Non variceal Upper GI bleeding 90% Variceal bleeding 10%

  18. Causes

  19. Oesophageal varices Esophageal Varices Bleeding esophageal varices

  20. Oesophagitis

  21. Angiodysplasia

  22. Other causes Gastric varices Mallory Weiss Tear Esophagitis

  23. Glasgow-Blatchford Score Scores of 6 or more were associated with a greater than 50% risk of needing an intervention

  24. Variceal bleeding

  25. Sengstaken-Blakemore tube

  26. Child Pugh classification

  27. Further reading/References • Clinical Anatomy: Applied Anatomy for Students and Junior Doctors by Prof H Ellis • Review Of Medical Physiology by W F Ganong • Guidelines - http://guidance.nice.org.uk/CG141 - http://www.sign.ac.uk/guidelines/fulltext/105

  28. Any questions ??? If you need e-copy of the presentation Email : g.muthukumarasamy@nhs.net

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