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Upper GI Bleeds. Definition. Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno-jejunal flexture . . Haematemesis or Malaena

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definition
Definition
  • Bleeding from a gastrointestinal source proximal to the ligament of Treitz which occurs at the duodeno-jejunalflexture.
  • Haematemesis or Malaena
  • Abdo pain, hypotension (fatigue etc), purpura, liver pathology stigmata (spleno-hepato- megaly, spider naevi, jaundice, hepatic flap
rx upper bleeds
Rx – Upper Bleeds
  • Resuscitate/ABC - hypovolemia:
      • Rapid history and examination, note age.
      • Monitor pulse and BP every 30 mins
      • Take blood for haemoglobin, urea, electrolytes and grouping; Establish IV access
      • Give blood transfusion/colloid if necessary
      • Indications: 1. If in shock: BP<100, pulse >100bpm 2.haemoglobin<10g/dL
      • Oxygen therapy for shocked patients
slide5

Correct any clotting abnormalities – Vit K? Warfarin?

  • Vasopressin
  • PPI
  • Urgent Endoscopy – adrenaline/banding (arrests bleeding)
definition1
Definition
  • The loss of blood from the GI tract distal to the ligament of Trietz.
  • This is the anatomical marker for the junction between the duodenum and the jejunum.
causes
Causes

Meckeldiverticulum, intussusception, polyposis syndromes, and IBD are the common causes of GI bleeding in children and adolescents 

signs and symptoms
Signs and Symptoms
  • Maroon/red stained stools (hematochezia) or bright red blood from the rectum.
  • Malaena may also occur but it points more towards upper GI bleeds.
  • Hypotension; tachycardia
  • Pallour, weakness, fainting and other signs of anaemia (if chronic)
  • Perform History and ask about IBD, weight loss, FHx of Ca, stomach pain, bleeding disorders, last period.
rx lower bleeds
Rx – Lower Bleeds
  • Resuscitation and initial assessment – same as in upper GIT bleeding
  • Localization of the bleeding site – using investigations such as rectal examination, proctoscopy, sigmoidoscopy, colonoscopy, etc)
  • Therapeutic intervention to stop bleeding at the site.
  • Rx Anaemia
h pylori and pud
H. Pylori and PUD
  • 95 % DU assoc. With H. Pylori; 80% GU; 4:1
  • Risks: Smoking, NSAIDs, aspirin, steroids, increased acid secretion, increased gastric emptying, stress???, AGE (x>80)
  • Gram –ve, burrows into mucoidlining;
  • Dx:13C Urea breath test
      • Serological tests – IgG antibodies – 80% sensitive & specific
      • Endoscopy: Rapid urease test  gastric biopsies added to urea soln. with phenol red. If present  ph inc.↑ & causes colour change
        • Culture  biopsies cultured on special medium with antibiotic sensitivities.