1. GASTRO INTESTINAL BLEEDING
AN APPROACH TO DIAGNOSIS
GASTRO INTESTINAL BLEEDING
Gatot Sugiharto, dr. SpPD
Internal Medicine Dept. Faculty of Medicine
Wijaya Kusuma University
2014

2. DEFINITIONS

3. PATHOPHYSIOLOGY OF GI BLEEDING

4. SOURCES OF GI BLEEDING

8. UPPER VS LOWER LOWER GI BLEED UPPER GI BLEED
A directed history and physical is pertinent to directing treatment and diagnostic testing. 9

9. UPPER VS LOWER UPPER GI BLEED LOWER GI BLEED
A directed history and physical is pertinent to directing treatment and diagnostic testing. 10

10. UPPER GI BLEED RISK FACTORS
NSAID USE
H. PYLORI INFECTION
INCREASED AGE
UPPER GI BLEEDING ACCOUNTS FOR APPROXIMATELY 350,000 HOSPITALIZATIONS PER YEAR.

11. ETIOLOGY OF UPPER BLEEDS

12. CAUSES OF UPPER GI BLEED(1)

13. CAUSES OF UPPER GI BLEED (2)

14. CAUSES OF UPPER GI BLEED (3)

15. CAUSES OF LOWER GI BLEEDING (1)

16. CAUSES OF LOWER GI BLEEDING (2)

17. PHYSICAL EXAM NGT Positive: UGIB
NGT Negative: bleeding stopped. Bleeding is beyong pylorus 20

18. LAB WORK UP CBC BASIC PANEL BLOOD TYPE AND CROSSMATCH
SERIAL HGB
PLATELETS
BASIC PANEL
LFT, RFT
BLOOD TYPE AND CROSSMATCH
COAGULATION STUDIES
STOOL WBCS TO EVALUATE INFECTIOUS
IMAGING STUDIES?
BUN/Cr > 30 indicates GI bleed, prob UGIB. 21

19. HOW TO LOCATE OF BLEEDING

20. EVIDENCE OF UPPER GI BLEED
HEMATEMESIS (50%)
NGT WITH POSITIVE BLOOD ON ASPIRATE
HEMATOCHEZIA (11%)
MELENA (BLACK TARRY STOOLS)
THIS DEVELOPS WITH APPROXIMATELY CC OF BLOOD IN THE UPPER GI TRACT.
STOOL TURNS BLACK AFTER 8 HOURS OF SITTING WITHIN THE GUT.

21. COMMON CAUSE OF UPPER GI BLEEDING
DUODENAL ULCER
VARICOSE

22. COMMON CAUSE OF UPPER GI BLEEDING
ANGIODYSPLASIA
ESOPHAGITIS

23. GI MALIGNANCY
GASTRIC CARCINOMA
ESOPHAGEAL TUMOR

24. SIGN & SYMPTOM OF LOWER GI BLEED
ACUTE (<3 DAYS) VS CHRONIC (>3 DAYS/SEVERAL DAYS)
HEMATOCHEZIA VS MELENA
BLOOD IN TOILET, CLEAR NGT ASPIRATE
NORMAL RENAL FUNCTION
USUALLY HEMODYNAMICALLY STABLE
<200ML : NO EFFECT ON HR**
>800ML: SBP DROPS BY 10MMHG, HR INCREASES BY 10
>1500ML: POSSIBLE SHOCK OR
10% HCT: TACHYCARDIA*
20% HCT: ORTHOSTATIC HYPOTENSION
30% HCT: SHOCK
STOPS SPONTANEOUSLY ( % OF THE TIME)
*Pocket Medicine, 3rd edition
**Barnet J and H Messmann H. Nat Rev Gastroenterol Hepatol 6, (2009). 27

25. MELENA VS HEMATOCHEZIA

26. ETIOLOGY OF HEMATOCHEZIA
Mnemonic for: painful --> I = infectious, inflam, ischemic
Ischemic colitis - usually elderly, transient hypoperfusion of mesenteric arteries, resulting in pain from episodic low BP or vasospasm.
Water shed area: splenic flexure AND rectosigmoid.
Barnet J and H Messmann H. Nat Rev Gastroenterol Hepatol 6, (2009). 29

27. COMMON CAUSE OF LOWER GI BLEED
COLONIC POLYPS
DIVERTICULOSIS

28. COMMON CAUSE OF LOWER GI BLEED
COLON CARCINOMA
HEMMORHOIDE

29. MANAGEMENT OF GI BLEED (1)

30. MANAGEMENT OF GI BLEED (2)