1. GASTRO INTESTINAL BLEED
Dr. PRAVEEN PEDDI

2. :: DEFINITION ::
UPPER
Ligament of TREITZ
LOWER

3. Esophageal and Gastric Varices
MOST COMMON CAUSES
UPPER GI BLEED
LOWER GI BLEED
Peptic Ulcer Disease
Erosive Gastritis
Esophagitis
Esophageal and Gastric Varices
Mallory-Weiss Tear
others
Diverticulosis
Vascular Ectasia
Mesenteic Ischemia
Ischemia Colitis
Meckel Divrticulum

4. CAUSES OF UGI BLEED

5. CAUSES OF LOWER GI BLEED

7. PEPTIC ULCERS

8. ESOPHAGEAL AND GASTRIC VARICES

9. Erosive gastritis and esophagitis

10. MALLORY-WEISS TEAR

12. AORTO ENTERIC FISTULA

13. DIEULAFOYS LESIONS

14. DIVERTICULOSIS

15. MESENTERIC ISCHEMIA and ischemic colitis

16. RISK FACTOR. vasculitis Hyper coagulable state
Aneurysmal rupture
vasculitis
Hyper coagulable state
Prolonged strenous exercises
IBS
Diagnosis requires a high index suspicion
age>60
Atrial Fibrillation
CHF, MI
post pondial and pain
Diagnostic study of choice. ANGIOGRAPHY
Prognosis

18. MECKEL DIVERTICULUM

19. OTHER CAUSES Coliti Rectal ulcers Trauma IBD Polyp Carcinoma
hemorrhoids

20. Clinical presentation
UGI BLEED
Hematemesis
Coffee ground emesis
Melena
ENT examination
LOWER GI BLEED
Hematochezia
Frank blood
Genito urinary tract

22. On examination Hypotension Tachycardia Decreased pulse pressure
Tachypnea
Shock- cool clamy skin, increased capillary refilling
Liver disease—spider navi., palmar erythema, gynecomastia, jaundice
Coagulopthy

23. INVESTIGATIONS Grouping and cross matching CBP BUN Creatinine
Electrolytes
Coagulation test
ECG

24. Diagnostic studies UPPER GI BLEED. LOWER GI BLEED
UGI endoscopy Lower GI endoscopy
Naso Gastric Tube Angiography
Scintigraphy
multiditector CT

25. Forrest classification
1a—spurting hemorrhage
1b—oozing hemorrhage
2a—visible vessels
2b—adherent clot
2c—flat pigmented hematin on ULCER base
3—without signs of hemorrhage

28. treatment
PRIMARY : Immediate resuscitation O2 inhalation Crystalloids Blood transfusion

29. SECONDARY treatment Early therapeutic endoscopy Injection therapy
Coagulative therapy
Endoscopic clips
Band ligations

30. Peptic ulcers Crystalloids Colloids
PPI– Lansoprazole- 60mg bolus f/b 6ml/hr
Pantoprazole – 80mg bolus f/b 8ml/hr
Esomeprazole “”. “” “”

31. Variceal bleed Colloids, Albumin
Octreotide--- 50microgram Bolus f/b 50microgram /hr
Vassopressin
Beta blockers and Nitratesh

32. Endoscopic BANDING AND SCLEROTHERAPY

34. Balloon tamponade

35. Tips
Trans jugular Intra hepatic Porto systemic shunts

36. DISPOSITION AND FOLLOW UP
Adverse outcome
Initial hematocrit <30%
Initial SBP <100
Red blood in NG lavage
H/O Cirrhosis

37. Glasgow-blathford bleeding score
BLOOD UREA
HAEMOGLOBIN
SYSTOLIC BLOOD PRESSURE
PULSE RATE
MELENA
SYNCOPE
HEPATIC DISEASE
CARDIAC FAILURE

38. ROCKALL RISK scoring SYSTEM