Digestive System Bleeding.pptx

Digestive System Bleeding Assist. Assist. Prof. Prof. Dr. Dr. Mert Mert BEKTAŞ BEKTAŞ Istanbul Aydın University Faculty of Medicine Department of Internal Medicine Definition  all forms of bleeding in the gastrointestinal tract  from mouth to the rectum  hematemesis - vomiting up blood  melena -...

Digestive System Bleeding Assist. Assist. Prof. Prof. Dr. Dr. Mert Mert BEKTAŞ BEKTAŞ Istanbul Aydın University Faculty of Medicine Department of Internal Medicine Definition  all forms of bleeding in the gastrointestinal tract  from mouth to the rectum  hematemesis - vomiting up blood  melena - tarry stool containing altered blood  hematochezia - bright red blood in stool a) esophageal varices bleeding b) vascular ectasia 2 Symptoms  hematemesis vomiting up blood  melena tarry stool containing altered blood  hematochezia bright red blood in stool 3 Hematemesis  Vomiting blood  Bright/fresh red blood (early time or active bleeding)  In the form of dark coffee grounds (digested bleeding)  Hemorrhage location  nasopharynx, esophagus, stomach, or duodenum 4 Melena  black, tarry defecation  breakdown of blood as a result of degradation by intestinal bacteria  bleeding from upper GI, small bowel, proximal colon  occurs within hours after 50-100 ml of bleeding passes through the GI tract 5 Hematochezia  rectal bleeding of light red color  colonic and anorectal bleeding  active upper GI or small bowel bleeding 6 Types 1) Upper Gastrointestinal Bleeding (2/3)  hematemesis or melena  peptic ulcer disease  esophageal varices  cancers  angiodysplasia 2) Lower Gastrointestinal Bleeding (1/3)  hematochezia  hemorrhoids  cancer  IBD  angiodysplasia 7 Ligament of Treitz thin muscle connecting the the duodenum and jejunum (the small intestine's first and second parts) 8 Diagnosis observation of blood in the stool or vomit fecal occult blood test for colon cancer screening Gastric aspiration and or lavage tube is inserted into the stomach via the nose Laboratory testing CBC, hemoglobin, hematocrit Radiology CT angiography 9 Etiology of upper GI bleeding Peptic ulcer disease (oesophageal, gastric or duodenal ulcers) due to H. pylori, NSAID use, alcohol, steroid use Zollinger-Ellison syndrome (gastrin-secreting tumour causing multiple ulcers) Esophagitis and gastroduodenal erosions due to aspirin, other NSAIDs, steroids Esophageal varices due to portal hypertension, usually associated with chronic liver disease 10 Etiology of upper GI bleeding Mallory-Weiss tears secondary to prolonged vomiting Dieulafoy’s lesion tortuous arteriole usually upper part of lesser curve GORD Upper GI malignancy Vascular malformations Dieulafoy ulcer and angiodysplasia 11 Etiology of lower GI bleeding Diverticular bleeding (most common cause) Hemorrhoids Anal fissure Rectal ulcer IBD Colon ischemia Gastrointestinal angiodysplasia 12 History History of presenting complaint Haematemesis – can be bright red or coffeeground Melaena – distinctive smell, tar-like Hematochezia - red blood via rectum Volume of blood loss Dyspesia Dizziness Chest pain Prolonged vomiting/retching 13 Constitutional symptoms History Past medical history previous GI bleed known varices malignancy liver disease Medications NSAIDs steroids anticoagulants Allergies Social history alcohol A- ulcerative tumor at the anterior wall of the antrum B- after APC and hemostasis achieved 14 Physical Examination Hypovolemia hypotension, tachycardia, orthostatic hypotension Examination of the abdomen scars, tenderness, palpable mass, ascites, splenomegaly, caput Medusa other system inspections Palmar erythema, Dupuytren's contracture, gynecomastia, spider talingiectasia characteristics of feces— melana or fresh bleeding Nasogastric lavage 15 Treatment airway management fluid resuscitation intravenous fluids or blood transfusions Proton pump inhibitor (PPI) endoscopic hemostatic treatment Somatostatin, Terlipressin, octreotide, albümin Sengstaken-Blakemore tube Argon plasma coagulation 16