GI Bleeding.ppt

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1、G.I.BleedingPresentedby:AhmedT.Al-SuwaidiMohamedS.Al-HoqaniG.I.BleedingCase50yrs,Pakistani,maleC/O:Bleeding/rectum&Abd.painPainlessbleeding,1yr–excessbleeding,1monthBlack,4-5times/day,littlequant.Abd.painVomiting,1weekG.I.BleedingCaseM.H:*nopepticulcerdisease*nomedications(NSAI

2、Ds)*nourinarysymptoms*notknownDM,HPTN,IHD**weightlossG.I.BleedingCaseO/E:*Afebrile*nopallor*notdyspneaic*nolymphoadenopathies*noS.C.L.NG.I.BleedingCaseVitalSigns:*Pulse:78bts/min*BP:130/80*RR:18br/minHeart:NADLung:NADG.I.BleedingCaseAbd.:*notdistended*noepigast.tenderness*tende

3、r,firm,partlymobilemassatRtlumbarregion.*spleennotpalpable*Ltlobeliverpalpable,mildlytender*bowelsoundspresentG.I.BleedingCasePR:*noenlargedpiles*noactivebleeding*nopalpablemass*nobloodonfingerECG,CBC,SrAmylase,Bleedingprofile,AbdX-ray,fecalloadingascendingcolonG.I.BleedingCase

4、LabResults:*Hb:14.1g/dl*Plt:252*103*Hypochromic,microcytic*PT:17.3sec*aPTT:35.4sec*SrAmy:129U/l106U/l*Na+:140mmol/l*K+:4.1mmol/l*BUN:17mg/dlG.I.BleedingAcuteVsChronicAcuteUpperG.I.Bleeding:AcuteLowerG.I.Bleeding:AcuteUpperG.I.BleedingHaematemesisMelaenaSite&TimeAcuteU.G.I.Blee

5、ding·Aetiology:1.Drugs(Aspirin&NSAIDs)2.Alcohol3.Chronicpepticulceration(50%ofGIhemorrhage)4.Others:refluxesophagitis,varices,gastriccarcinoma,acutegastriculcers&erosions.AcuteU.G.I.Bleeding·Clinicalapproach:1.recent(24hrs),thenhospitalized.2.ifsmallamount,noimmediateTx,because

6、CVScancompensate3.85%stopbleedingduring48hrs4.historyhelpsindiagnosingthecauseofthehemorrhage,eg:longhistoryofindigestion,orprevioushem.fromulcers.AcuteU.G.I.Bleeding·Clinicalapproach:5.factorsinclude:·age(60+)·amountofbldlost·continuingvisiblebldloss.·signsofchronicliverdiseas

7、e·classicalclinicalfeaturesofshockAcuteU.G.I.Bleeding·Clinicalapproach:6.liverdiseasesevere,recurrentbleeding(iffromvarices)7.splenomegalyportalhypertensionAcuteU.G.I.Bleeding·Immediatemanagement:**Emergencymanagement:·History+exam.·Monitor:pulse&BP/30min·Bldsample:haemoglobi

8、n,urea,electrolytes,grouping&cross-matching·I.v.access