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Aproach To A Patient With Ugib

The document outlines the approach to evaluating a patient with gastrointestinal bleeding, focusing on initial evaluation, history, physical examination, and necessary investigations. It includes case studies to illustrate the clinical presentation and management of patients with upper and lower GI bleeding. Key aspects include hemodynamic assessment, potential causes, and diagnostic steps such as endoscopy and laboratory tests.

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Nebiyu Tadesse
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20 views9 pages

Aproach To A Patient With Ugib

The document outlines the approach to evaluating a patient with gastrointestinal bleeding, focusing on initial evaluation, history, physical examination, and necessary investigations. It includes case studies to illustrate the clinical presentation and management of patients with upper and lower GI bleeding. Key aspects include hemodynamic assessment, potential causes, and diagnostic steps such as endoscopy and laboratory tests.

Uploaded by

Nebiyu Tadesse
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

APROACH TO A PATIENT

WITH
GI BLEEDING

By Samia metena

1
INITIAL EVALUATION
 Hemodynamic significance
• Shock : BP 100 mmHg 30% reduction
• Orthostatic drop, Upright tachycardia, tachypnea
• pallor, cool skin, light headedness, nausea, sweating,
thirst, urine output, syncope
 Ongoing or ceased 80%
 NG tube
 IV-Line
 Blood sample
 ICU
 Urgent or elective endoscopy 2
HISTORY & PE
 Upper GI or Lower GI?
• Hematemesis, melena(UGI>100ml of blood, for > 14 hrs, LGI)
• Hematochezia(LGI>UGI), wt loss, Intermittent blood in stool change in stool
cycle, abrupt painless, rectal exam
 Specific cause?
• Hx of PUD, smoking alcohol, FHx, epigastric pain,NSAIDs, epigastric
tenderness
• CLD history, peripheral stigmata's of CLD
• Alcohol; Vomiting; Hematemesis
• Bleeding from other sites, anticoagulants, LAP, HSM
• pallor, dyspnea, angina, and exertional weakness.

3
INVESTIGATIONS

• Hgb & hct- 24 to 48 Hrs, hct < 30%, type of anemia


• Mild Leukocytosis
• platlet& coagulation profile
• RFT: BUN
• LFT
• Stool: occult blood,fecal leukocytosis_culture

4
• NGT Dxic 16% False-VE, rate
Tx: Iced saline
• Endoscopy
Accuracy 90%
Visualization
Therapeutic intervention
Urgent indications
Contraindications
• Barium radiography: chronic cases
• Techetium labeled red cell Scintigraphy, Angiography
• Colonoscopy
5
Case 1
A 24 yrs old man is brought to the emergency room by
ambulance after he suffers an episode of hematemesis
and syncope at a local bar. He has never suffered prior
GI bleeding, and regularly takes aspirin for the relief of
chronic back pain. During your interview, he passed
several liquid, maroon stools. Your physical
examination reveals a supine BP and pulse of 120/75
mmHg and 110/min, respectively. When you sit him
upright he complains of feeling faint and his systolic
pressure drops to 90 mmHg by palpation. His
abdomen is non tender and distended. Shifting
dullness is elicited and the spleen tip is palpable. The
initial Hg is 15 gm/dl and HCT is 45%. 6
1. How do you know this man has lost a significant
amount of blood?
2. What are the most likely cause of this man’s upper
GI bleeding and what should the next diagnostic
step be?
3. What emergency actions you do at the emergency
room?
4. How can he be managed then after?

7
Case 2
• A 50 years old man has had recurrent and at times
severe epigastric abdominal pain for the past
several years. Each time has taken antacids, with
symptomatic relief. The most recent episode began
1 week ago and has not responded completely to
antacids. The pain now wakes him up at night. He
smokes one pack of cigarettes per day, and he takes
aspirin several times a week. His family history is
unremarkable. Your examination reveals moderate
epigastric tenderness without evidence of a mass.
The stool is brown and positive for occult blood.
8
1. What are this man’s risk factors for peptic ulcer
disease?
2. What diagnostic tests should you consider?
3. What is the specific treatment?

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