general git bleeding
TRANSCRIPT
-
8/8/2019 General GIT Bleeding
1/21
Group 1
Fadzliana
Yamuna
Atirah
Siti Rohani
-
8/8/2019 General GIT Bleeding
2/21
GI bleeding are bleeding describes every formof hemorrhage (loss of blood) in thegastrointestinal tract, which including theesophagus, stomach, small intestine, largeintestine or colon, rectum and anus.
Blood loss from GI tract occurs in one orcombination of four ways:
Hematemesis
Melena
HematocheziaOccult bleeding
-
8/8/2019 General GIT Bleeding
3/21
Hematemesis - Vomiting of bright red blood
usually represents bleeding proximal to
the ligament of Treitz
Hematochezia - Bright red blood per rectum
indicates a lower GI source of bleeding
Blood has a laxative effect so with massive
bleeding the stool may be bright red
-
8/8/2019 General GIT Bleeding
4/21
Blood streaks on the stool indicates anal
outlet bleeding
Blood mixed with stool indicates bleedingsource higher than the rectum
Blood with mucus indicates an infectious orinflammatory disease
Currant jelly-like material indicates vascularcongestion and hyperemia (intussusceptionor midgut volvulus)
-
8/8/2019 General GIT Bleeding
5/21
Maroon-colored stools indicatevoluminous bleeding proximal to therectosigmoid area
Melena, passage of black, sticky (tarry)stools suggests upper GI tractbleeding, but can be as distal as theright colon
Hematemesis suggests a large bleedwith possible recurrence, melena aloneindicates less voluminous bleeding
-
8/8/2019 General GIT Bleeding
6/21
Common
Nasophar ngealleeding
Erosi eEsophagitis
Pepti l er
astritis ( . pylori)
allory-Weiss tear Prolapsegastropathy
Less Common
Bleeding disorders
Duplication cyst
Foreign body
Tube trauma
Vascular malformation
Esophageal varices
-
8/8/2019 General GIT Bleeding
7/21
-
8/8/2019 General GIT Bleeding
8/21
-
8/8/2019 General GIT Bleeding
9/21
Common
Anal fissure
Infectious colitis
Salmonella, Shigella,Campylobacter,
C.diff
Inflammatory bowel
disease
Intussusception
Upper GI source
Less Common
Meckels diverticulum
Duplication cystHirschsprungs enterocoliti
Gangrenous intestine
Vascular malformation
-
8/8/2019 General GIT Bleeding
10/21
-
8/8/2019 General GIT Bleeding
11/21
Neonates
Most ommon sesof rent neonatal Ileeds incl de acterial enteritis,milk rotein
aller ies, int ssuseption,swallowedmaternallood,anal fissures,and l mphonodular
hyperplasia.
Erosionsof theesophageal,gastric,andduodenalmucosaarealsoa frequent cause for trueneonatal
I leeding.
Somedrugsare implicated inneonatal I leeds: NSAIDs,heparin,and tolazoline,whichareused forpersistent fetal circulation.
Indomethacin,used forpatent ductusarteriosus
-
8/8/2019 General GIT Bleeding
12/21
Infants
GI mucosal lesions and irritations are the mostcommon causes of GI bleeding in infants andchildren. This category includes esophagitis,gastritis, duodenitis, ulcers, colonic polyps,
and anorectal disorders.
Intussusception is a frequent and importantetiology of GI bleeding in this age group
Other causes include infectious diarrhea,midgut volvulus, Meckel diverticulum,arteriovenous malformation
-
8/8/2019 General GIT Bleeding
13/21
Children
Duodenal ulcer, Mallory- eiss tear, andnasopharyngeal bleeding are important causes ofbleeding in older children.
Juvenile polyps also occur frequently in children ofthe age group between 2 and 8 years old (with apeak from 3-4 years) causing painless rectal
bleeding usually from polyps in the rectosigmoidregion
Helicobacter pylorihas been associated with pepticulcer disease in children. However, H pylori
infection is common and usually asymptomatic.
-
8/8/2019 General GIT Bleeding
14/21
Acute gastrointestinal bleeding first will appear as
vomiting of blood, bloody bowel movements, or
black, tarry stools. Blood may look like "coffee
grounds."Symptoms associated with blood loss can include
the following:
Fatigue
eakness
Shortness of breath
Abdominal pain
Pale appearance
-
8/8/2019 General GIT Bleeding
15/21
-
8/8/2019 General GIT Bleeding
16/21
Upper GI tract
Common signs:
Hematemesis(clear indicator)
melena
melena orhematochezia with
hemodynamic instability
Lower Gl tract
Common signs:
Hemaochezia is usualalthough an upper GIlesion may bleedrapidly that blood does
not remain in theintestine long enoughfor melena to develop
-
8/8/2019 General GIT Bleeding
17/21
The test used most
often to look for thecause of GI bleeding
is called endoscopy
Used to identify the
source of bleeding
A type of endoscopycalled colonoscopy
looks at the large
intestine.Our endoscope is broken, but
luckily nurse has her mobile phone
camera its quite small
Our endoscope is broken, but
luckily nurse has her mobile phone
camera its quite small
-
8/8/2019 General GIT Bleeding
18/21
Diagnosis is often based on direct
observation of blood in the stool. This can
be confirmed with a fecal occult blood test.
-
8/8/2019 General GIT Bleeding
19/21
Initial focus in any patient with a form of gastrointestinal hemorrhage
is on resuscitation, as any further intervention is precluded by thepresence of intravascular depletion or shock.
Fluid resuscitation
intravenous fluids and blood transfusion may be administered.
Acid suppression:in an upper GI source, proton pump inhibitors reduce gastric acidproduction and enhance healing of bleeding lesions.
Inhibition of fibrinolysis:
in ongoing bleeding, tranexamic acid reduces fibrinolysis and may
decrease blood product requirements.
Correction of coagulopathy:
if coagulation parameters (e.g. prothrombin time) are deranged,vitamin K or fresh frozen plasma may need to be administered.
-
8/8/2019 General GIT Bleeding
20/21
Reduction of portal pressure:
if the bleeding is thought to be due to esophagealvarices (a complication of cirrhosis of the liver),vasopressin analogues and rarely octreotide may beadministered. Rarely, a Sengstaken-Blakemore tubemay be inserted to mechanically compress varices.
Urgent endoscopy:if the bleeding cannot be managed medically an urgentesophagogastroduodenoscopy (EGD/OGD) may identifysources of bleeding. This is a high-risk procedure bestperformed under safe circumstances in the intensivecare unit or operating theatres.
Surgical intervention:
in extreme cases of bleeding, laparotomy may berequired to identify the bleeding source.
-
8/8/2019 General GIT Bleeding
21/21
Esophagogastroduodenoscopy (EGD/OGD)