Hemetamesis and Hemetochezia (Acute GI Hemorrhage). Dr. Wu ShuMing GI Dept. RenJi Hospital SSMU. Five Ways of GI Bleeding. Hematemesis ： vomitting of blood of altered blood （ coffee grounds ） indicates bleeding proximal to ligament of Treitz
Dr. Wu ShuMing
GI Dept. RenJi Hospital
Peptic ulcer ；
Gastropathy （alcohol， aspirin， NSAIDs， stress）；
Esophageal or intestinal neoplam
Esophagitis； Malloy-weiss tear，
Hemoptysis: Swallowed blood
Anticoagulant fibrinoloytic therapy:
Telangiectases； aneurysm ；vasculitis；Dieulafoy ulcer； AV malformation
Connective tissue disease；
Hemabilia（biliary origin；Crohn`s disease；amyloidosis , hematological diseases
The classical presentation of gastric ulcer :
with weight loss and indigestion made worse by eating,
patients more often describe symptoms that would fit equally well for duodenal ulcer - investigation with barium meal or (preferably) endoscopy is, of course, appropriate for either. Benign ulcers may occur at any site in the stomach, but are commonest on the lesser curve away from acid-secreting epithelium.
Location of benign gastric ulcersin relationship to the distance from the pylorus. The majority of benign ulcers will be found on the lesser curvature within 3 cm of the angulus.
Bleeding Survey: Endoscopic Findings in 214 Patients With Clear Nasogastric Aspirates
FINDING NUMBER OF PATIENTS INCIDENCE (%)
Duodenaal ulcer 64 29.8
Gastric erosions 57 6.5
Gastric ulcer 47 21.9
Esophagitis 23 10.7
Duodenitis 21 9.8
Varices 11 5.1
Mallory-Weiss tear 10 4.7
Neoplasm 8 3.7
Stomal ulcer 7 3.3
Esophageal ulcer 2 0.9
Other 18 8.4
Acute upper Gastrointestinal Hemorrhage
Rapid assessment Monitor hemodynamic status
Fluid resuscitation Gastric lavage(?)
self-limited (80%) bleeding (10-20%)
Empiric medical therapy
endoscopy Site not localized Localized
enteroscopy, radioisotope s scan, angiography,
Definitive therapyDefinitive therapy
Endoscopic view of a Mallory-Weiss tear with active bleeding (gastric lumen is at top left). B, Endoscopic view of an organized clot adherent to a Mallory-Weiss tear (gastric lumen is at bottom left ).
Endoscopic view of a Dieulafoy lesion on the lesser curvature of the stomach
Endoscopic view of the gastric antrum with watermelon stomach. The pylorus is at top center. Note the linear distribution pattern of the vascular lesions arranged radially around the pylorus.
Endoscopic views of ulcers with stigmata of recent hemorrhage. A, Duodenal ulcer with a visible vessel. B, Gastric ulcer with a red spot in the center of the crater. C, Duodenal ulcer with a red spot in the center of the crater. D, Purplish clot adherent to a gastric ulcer.
Typical picture of a trivial nonsteroidal anti-inflammatory drug (NSAID)-induced injury to the gastric mucosa. There are multiple small erosions with brown-black staining of the center as a result of local bleeding and petechiae.
Tuberculosis. Linear ulceration runs circumferentially along the interhaustral septum with tiny satellite ulcerations. This must be distinguished from the longitudinal linear ulcerations seen in inflammatory bowel disease.