UPPER GIT BLEEDING HEMATEMESIS. OBJECTIVES. History & Examination & portal system Definition & Related terms Clinical presentation Differential Diagnosis Hematemesis VS Hemoptysis Management . Anatomy of the Portal System. History. Definition.
1 in 1000 in us who experienced upper GI bleeding
Men :women 2 : 1
Mortality rate 10%
portal circulation systemic circulation
left gastric veinAzygos vein
Esophageal Varices UGIB
Duodenal ulcer. (commonest)
(Alcohol ,smoking, stress)
F-I/a. Spurting arterial bleeding
F-I/b. Oozing bleeding
F-II/a. Visible vessel on the base of ulcer
F-II/b. Coagulum in the ulcer
F-II/c. Coffee ground ulcer base
because of rebleeding: 20-30 %
Same as PU
M>F 3:1 , 50+ yrs.
Epigastric pain induced by eating.
Nausea and vomiting.
Anaemia from chronic blood loss.
Avoid smoking and food that cause pain.
Antacids for symptomatic relief.
H2 blockers .
Stiching of ulcer
Salycil containing drugs
GI TRACTRESPIRATORY TRACTDark red or brown Bright red
In clumps Foamy, runny & bubbly
Mixed with food mixed with mucous
Acidic pH alkaline pH
Stomachache, abdominal discomfort chest pain, warmth
Nausea, retching before and after episode persistent cough
mild bleeding severe bleeding
Normal Pulse Weak & Rapid
Normal BP BP>10Hg
Normal breathing Deep & Tach
Mucosa slightly dry Parched
Slightly Urine OP Anuris
Hematemesis is vomiting of gross blood.
If this is not the case, the patient is generally administered a proton pump inhibitor (e.g. omeprazole), given blood transfusions (if the level of hemoglobin is extremely low, that is less than 8.0 g/dL or 4.5-5.0 mmol/L), and kept nil per os(nil by mouth) until endoscopy can be arranged. Adequate venous access (large-bore cannulas or a central venous catheter) is generally obtained in case the patient suffers a further bleed and becomes unstable.
In a "hemodynamic ally significant" case of Hematemesis, that is hypovolemic shock, resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary.