Download - Aetiology of upper gi bleed
UPPER GI BLEED
AETIOLOGY
PEPTIC ULCER
• Breaks in the mucosal surface >5 mm
• 2 types-• Duodenal Ulcers • Gastric Ulcers
• NSAIDS H.Pylori
PEPTIC ULCER
GASTRIC EROSIONS
• GASTRITIS• Alcohol intake• NSAID use• Stress
ESOPHAGITIS
• Inflammation of esophageal mucosa
a) GERD
b) Barret Esophagus
c) Chemical Esophagitis-alcohol,acids,alkalis
d) Infectious esophagitis- HSV,CMV,fungal
Mallory-Weiss tear• Longitudinal tears
• Alcoholics
• Symptoms :• Vomiting• retching • Coughing
HEAMATEMESIS
ESOPHAGEAL VARICES
• Liver diseases– Cirrhosis
• Portal Hypertension
NEOPLASMS
• Ca.esophagus-
Squamous cell Ca
Adeno Ca
• Ca.stomach-Second most common Tumor
LESS COMMON CAUSES
• Vascular Malformations
Hereditary hemorrhagic telangiectasias
• Aorto-duodenal Fistula
• Hemosuccus pancreaticus
Bleeding from the bile duct or pancreatic duct
CLINICAL PRESENTATION
Bleeding - present in 5 ways.
1. Hematemesis - red blood or "coffee-ground" material.
2. Melena - black, tarry, foul-smelling stool.
3. Hematochezia - passage of bright red or maroon blood from the rectum.
4. Occult GI bleeding –
absence of overt bleeding
fecal occult blood test - +ve
presence of iron deficiency.
5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea.
I. HAEMATEMESIS
• vomiting of blood follows bleeding from esophagus ,stomach and duodenum( above the duodenal flexure)
COMMON CAUSES
i. Ruptured oesophageal varices
ii. Esophageal carcinoma
iii. Chronic gastric ulcer
iv. Carcinoma stomach
v. chronic duodenal ulcer
vi. Mallory Weiss syndrome
LESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia
• If the source of bleeding is above gastro-oesophageal sphincter ( eg : oesophageal varices) fresh blood wells up in mouth than being actively vomited
Mallory – Weiss tear-
patient vomits several times
fresh blood only appears after the initial vomit
• Sudden loss of > 20%
-tachycardia , hypotension, faintness and sweating
• Brisk hematemesis -from large vessel in an ulcer BRIGHT RED
• Bright red blood –naso or oro pharynx
• Slower upper GI bleeding- mixing of blood with gastric juice
darker, like that of ground coffee
II. MELAENA
- black , tarry stools containing occult blood
-Upper GI bleeding -Haemorrhage from right side of
colon -appx 60 ml of blood - single
black coloured stool
Blood for 14 hrs in the GI tract• Characteristics
i. Black tarry stool- due to production of acid haematin
ii. Offensive odour - acid haematin is altered by bacteria
iii. Semisolid in consistency
iv. Usually associated with vertigo , dizziness, syncopal attack during defecation
• Causes – all the causes of haematemesis may produce melaena
• Rarely, swallowed blood give rise to melaena: epistaxis
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