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UPPER GASTROINTESTINAL BLEEDING What Undergraduates should know ?

UPPER GASTROINTESTINAL BLEEDING What Undergraduates should know ?. Prof SM Chandramohan Prof and HOD Department of Surgical Gastroenterology and Center of Excellence for Upper GI Surgery Madras Medical College and Rajiv Gandhi Government General Hospital Chennai.

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UPPER GASTROINTESTINAL BLEEDING What Undergraduates should know ?

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  1. UPPER GASTROINTESTINAL BLEEDINGWhat Undergraduates should know ? Prof SM Chandramohan Prof and HOD Department of Surgical Gastroenterology and Center of Excellence for Upper GI Surgery Madras Medical College and Rajiv Gandhi Government General Hospital Chennai

  2. Can download this presentation from www.esoindia.org Prof SM Chandramohan Prof and HOD Department of Surgical Gastroenterology and Center of Excellence for Upper GI Surgery Madras Medical College and Rajiv Gandhi Government General Hospital Chennai

  3. DEFINITION PLAN OF THE TALK CAUSES EVALUATION TREATMENT

  4. DEFINITION PLAN OF THE TALK CAUSES MEDICAL ENDOSCOPIC SURGICAL EVALUATION TREATMENT

  5. DEFINITION Any bleeding from The gastrointestinal Tract above the Level of ligament of Treitz is upper GI Bleeding

  6. DEFINITIONS • Acute GI bleed • < 3 days duration • hemodynamic instability • requires blood transfusion • Overt vs. occult • overt = visible blood (melena, bright red blood, coffee grounds) • occult = only detected by lab tests

  7. COMMON CAUSES OF UGI BLEED

  8. NSAID • (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 bleeding RISK FACTORS

  9. A AIRWAY B BREATHING C CIRCULATION

  10. Examination Tell tale signs… Chronic Liver Disease Portal Hypertension

  11. Examination Not to miss…….. Haemodynamic stability Signs of coagulation dysfunction Signs of Liver cell failure PR

  12. Bleeding PR

  13. As he comes…………. Resuscitate and Examine Simultaneously…….

  14. Form a team………. Wide bore IV line…… preferably central line (take samples at the same time) Naso gastric tube Urinary Catheter ALERT OTHERS IN TEAM…….

  15. Blood Sample for Blood Group Haemogram including platelets Coagulation profile Liver function test Renal function Markers

  16. Blood Sample TRY NOT TO TAKE SAMPLES FREQUENTLY Except for serial evaluation

  17. WHICH TUBE AND WHY?

  18. Naso Gastric Tube or Senstaken tube?

  19. ROLE OF NASOGASTRIC TUBE 10 % of UGIB presents as LGIB Red blood vscoffee grounds NGT clears the gastric field for endoscopic visualization prevent aspiration of gastric content

  20. Endoscopy When to do? What is Possible? When not to do???

  21. Endoscopy One stop Shop Diagnose Assess Treat Reassess

  22. If Hemodynamically stable ENDOSCOPIC EVALUATION Identify Bleeding site Delineate cause Allow endotherapy

  23. ENDOSCOPIC MANAGEMENT VARICEAL NONVARICEAL

  24. ENDOSCOPIC VARICEAL LIGATION A rubber band is placed over the varix which then undergoes thrombosis,sloughing,fibrosis.

  25. ENDOSCOPIC SCLEROTHERAPY Involves injecting a sclerosant Intravariceal/perivariceal Common sclerosants Ethanolamine oleate Absolute alcohol Sodium morrhuate Sodium tetradecyl Hypertonic saline Polidocanol

  26. GLUE THERAPY Cyanoacrylate is a glue that is injected into Gastric varices Acts by forming a Cast over the varix on contact with blood

  27. Endoclip

  28. ULCERS IN POSTERIOR WALL BULB-GDA HIGH RISK ULCER FOR BLEED ULCERS IN THE HIGH LESSER CURVE - LGA DEFINITIVE MANAGEMENT OF NON VARICEAL BLEED SRH/LARGE ULCER >2 cm

  29. Non-Variceal - Modalities • Injection Therapy (a) Adrenaline (b) Sclerosants • Thermal Therapy (a) Monopolar (b) Bicap (c) Heater Probe (d) Argon Plasma Coagulation (e) Laser • Mechanical Therapy (a) Haemoclips Endoscopic Management

  30. Bleeding Peptic Ulcer - Stigmata Forrest Classification Endoscopic Management 1a – Spurting vessel 1b – Oozing from a vessel 2 – Clot in the ulcer base 3 – Ulcer without bleed

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