gastro intestinal bleeding an approach to diagnosis gatot sugiharto, dr. sppd internal medicine...
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GASTROGASTRO
INTESTINAL BLEEDINGINTESTINAL BLEEDING
AN APPROACH TO AN APPROACH TO
DIAGNOSISDIAGNOSIS
Gatot Sugiharto, dr. SpPDGatot Sugiharto, dr. SpPD
Internal Medicine Dept. Faculty of MedicineInternal Medicine Dept. Faculty of Medicine
Wijaya Kusuma UniversityWijaya Kusuma University2014 2014
UPPER GI BLEEDUPPER GI BLEED
• RISK FACTORS• NSAID USE
• H. PYLORI INFECTION
• INCREASED AGE
• UPPER GI BLEEDING ACCOUNTS FOR APPROXIMATELY 350,000 HOSPITALIZATIONS PER YEAR.
LAB WORK UPLAB WORK UP• CBCCBC
• SERIAL HGBSERIAL HGB
• PLATELETS PLATELETS
• BASIC PANELBASIC PANEL• LFT, RFTLFT, RFT
• BLOOD TYPE AND CROSSMATCHBLOOD TYPE AND CROSSMATCH
• COAGULATION STUDIESCOAGULATION STUDIES
• STOOL WBCS TO EVALUATE INFECTIOUSSTOOL WBCS TO EVALUATE INFECTIOUS
• IMAGING STUDIES?IMAGING STUDIES?
EVIDENCE OF UPPER GI BLEEDEVIDENCE OF UPPER GI BLEED
• HEMATEMESIS (50%)HEMATEMESIS (50%)
• NGT WITH POSITIVE BLOOD ON ASPIRATENGT WITH POSITIVE BLOOD ON ASPIRATE
• HEMATOCHEZIA (11%)HEMATOCHEZIA (11%)
• MELENA (BLACK TARRY STOOLS)MELENA (BLACK TARRY STOOLS)
• THIS DEVELOPS WITH APPROXIMATELY 150-200CC OF THIS DEVELOPS WITH APPROXIMATELY 150-200CC OF BLOOD IN THE UPPER GI TRACT. BLOOD IN THE UPPER GI TRACT.
• STOOL TURNS BLACK AFTER 8 HOURS OF SITTING WITHIN STOOL TURNS BLACK AFTER 8 HOURS OF SITTING WITHIN THE GUTTHE GUT..
• HEMATEMESIS (50%)HEMATEMESIS (50%)
• NGT WITH POSITIVE BLOOD ON ASPIRATENGT WITH POSITIVE BLOOD ON ASPIRATE
• HEMATOCHEZIA (11%)HEMATOCHEZIA (11%)
• MELENA (BLACK TARRY STOOLS)MELENA (BLACK TARRY STOOLS)
• THIS DEVELOPS WITH APPROXIMATELY 150-200CC OF THIS DEVELOPS WITH APPROXIMATELY 150-200CC OF BLOOD IN THE UPPER GI TRACT. BLOOD IN THE UPPER GI TRACT.
• STOOL TURNS BLACK AFTER 8 HOURS OF SITTING WITHIN STOOL TURNS BLACK AFTER 8 HOURS OF SITTING WITHIN THE GUTTHE GUT..
SIGN & SYMPTOM OF LOWER GI BLEEDSIGN & SYMPTOM OF LOWER GI BLEED• ACUTE (<3 DAYS) VS CHRONIC (>3 DAYS/SEVERAL DAYS)ACUTE (<3 DAYS) VS CHRONIC (>3 DAYS/SEVERAL DAYS)
• HEMATOCHEZIA VS MELENAHEMATOCHEZIA VS MELENA
• BLOOD IN TOILET, CLEAR NGT ASPIRATEBLOOD IN TOILET, CLEAR NGT ASPIRATE
• NORMAL RENAL FUNCTIONNORMAL RENAL FUNCTION
• USUALLY HEMODYNAMICALLY STABLEUSUALLY HEMODYNAMICALLY STABLE• <200ML : NO EFFECT ON HR**<200ML : NO EFFECT ON HR**
• >800ML: SBP DROPS BY 10MMHG, HR INCREASES BY 10>800ML: SBP DROPS BY 10MMHG, HR INCREASES BY 10
• >1500ML: POSSIBLE SHOCK>1500ML: POSSIBLE SHOCKOROR
• 10% HCT: TACHYCARDIA*10% HCT: TACHYCARDIA*
• 20% HCT: ORTHOSTATIC HYPOTENSION20% HCT: ORTHOSTATIC HYPOTENSION
• 30% HCT: SHOCK30% HCT: SHOCK
• STOPS SPONTANEOUSLY (80 - 85% OF THE TIME)STOPS SPONTANEOUSLY (80 - 85% OF THE TIME)
ETIOLOGY OF HEMATOCHEZIAETIOLOGY OF HEMATOCHEZIA
Barnet J and H Messmann H. Nat Rev Gastroenterol Hepatol 6, 637-646 (2009).
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