L26- GI bleeding Year 4 Internal Medicine Notes OmpathStudy

L26- GI bleeding Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / GIT -- Lecture 26 \nEditing file\n\n Gastrointestinal Bleeding \nObjectives:\n★ List the causes of Upper GI bleeding (UGIB).\n★ Explain the pathophysiology of shock from upper gastrointestinal bleeding.\n★ Identify the symptoms for patients presenting with GI bleeding.\n★ Discuss the risk stratification and initial assessment for patient with UGIB.\n★ Illustrate important physical signs in patients presenting with UBIG\n★ Outline the investigations required.\n★ Plan the management of patients with UGIB\n★ Recognize the clinical manifestations of upper gastrointestinal bleeding.\n★ Understand the principles of managing patients with upper gastrointestinal bleeding.\n★ Understand the principles of pharmacological therapy of patients with upper\ngastrointestinal bleeding.\n★ Recognize the differences between variceal and non-variceal hemorrhage.\n\n Color index: Color index:\nOriginal text Females slides Males slides\nDoctor’s notes Text book Important Golden notes Extra \n\n Introduction 2\n\n ◄ Anatomical landmarks and location of\ngastrointestinal bleeding:\nFrom 437 medicine team\nUpper GI Bleeding Lower GI Bleeding \nA source of bleeding above A source of bleeding\nthe ligament of Treitz Bleeding below the ligament\n(suspensory muscle of of Treitz.\nduodenum).\n➔ Including: ➔ Including: Small &\nEsophagus, stomach large bowel and the\nand duodenum rectum\n\n Acute upper gastrointestinal bleeding:\n● This is the most common gastrointestinal emergency, with approximately 10% mortality rate\n● The cardinal features are1:\n○ Haematemesis\n○ Melaena\n● Could present with unaltered blood can appear per rectum (hematochezia), but the bleeding\nmust be massive and is almost always accompanied by shock.\n\n lower gastrointestinal bleeding: EXTRA\n● Acute: Massive bleeding from the lower gastrointestinal tract is rare and presents with profuse\nred or maroon diarrhoea and with shock. usually from\n○ diverticular disease\n○ ischaemic colitis.\n● subacute or chronic: small bleeds. commonly caused by:\n○ Haemorrhoids. 2\n○ Anal fissures.3\n\n Chronic gastrointestinal bleeding:4\n● Patients usually present with iron-deficiency anaemia\n● can occur with any lesion of the GI tract that produces acute bleeding\n● The primary concern is to exclude cancer. particularly of the stomach or right colon and coeliac\ndisease\n\n1- symptoms are explained in details in coming slides. 2- Haemorrhoidal bleeding is bright red occur during or after defecation. (On toilet paper) 3-present with fresh rectal bleeding and anal pain occur during defecation. 4-hookworm is the most common worldwide cause of chronic GI blood loss. \n\n Upper GI Bleeding 3\n\n ★ UGIB Incidence; 57-78 cases per 100,000 population\n\n ◄ Etiology:\nPeptic ulcer disease (duodenal and Variceal bleeding 1 2nd most common\n01 gastric ulcers) The most common 02 cause\ncause of upper GI bleeding (36-50%)\n\n Mucosal Erosive disease (Esophagitis,\n03 Gastritis, Duodenitis) 04 Mallory weiss tear 2\n\n Gastric antral\nArteriovenous Dieulafoy's\n05 Malignancy\n06 malformation 07 vascular ectasia\n(GAVE)\n08 lesion 3\n\n 1 2\n\n1- common in egyptians due to high prevalence of hepatitis C and Schistosomiasis 2- a linear mucosal tear occurs at the oesophagogastric junction and produced by a sudden increase in intra-abdominal pressure. It often occurs after a bout of coughing or retching and is classically seen after alcoholic ‘dry heaves’.: recurrent vomiting which can be due to medications especially chemotherapy, pregnancy and classically after alcohol intake. They can have hematemesis or coffee ground emesis. Figure 1 explanation: When the tear goes to the full thickness causing muscle tear and not limited only to the surface then it is called boerhaave's syndrome and people die from it. pt will have bleeding to the mediastinum and mediastinitis which have a high fatality rate 3- rare, the vessel below the surface of the mucosa opens up and bleeds then disappears ( no abnormality found in endoscopy) can be picked up when the pt is actively bleeding Figure 2 explanation: it shows the risk of PUD, 4 millions years were lost due to PUD only \n\nMales slides\nGI Bleeding 4\n\n study conducted at alshumaisi hospital, this study shows the different presentations\nduring 13 years, the vast majority of GI of pt presenting with the same disease.\nbleeding were due to non variceal causes Having hematochezia is not always due to\nlower GI bleed, symptoms can vary.\n\n PUD is decreasing globally, could be due to better treatment of heartburn and PUD with PPI and h.pylori eradication also, the use\nof NSAIDs is not encouraged and usually given with a medications to prevent PUD\n\n Females\nRisk Factors\nslides\n- Age 65\n- Concomitant use of:\n- Previous peptic ulcer or ulcer-related upper GI\n○ NSAID & low dose aspirin can produce ulcers and\ncomplication\nerosions\n- Multiple or