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GASTROINTESTINAL
BLEEDING
by
Siti Nurdjanah
Gastroenterology-Hepatology Division, Internal Medicine,
Faculty of Medicine, University of Gadjah Mada,
Dr. Sardjito Hospital, Yogyakarta
DEFINITIONS
* HEMATEMESIS : is vomiting fresh red blood
A site of bleeding proximal to the duodenal-
jejunal junction ( Upper Treitz Ligament )
The Colour of vomitus depends on how long
the blood has been in the stomach
* Coffee ground vomiting is vomiting of altered
black blood
* Melaena is the passage of black tarry stools
Causes of Haematemesis
and Melaena
Oesophagus
Oesophageal Varices
Mallory-Weiss tear
Oesophageal carcinoma
Reflux oesophagitis
Foreign body
Causes of Haematemesis
and Melaena
Stomach
Peptic ulcer
Erosions/ Gastritis
Gastric varices
Portal hypertensive gastropathy
Gastric carcinoma
Lymphoma
Leiomyoma
Angiodysplasia (including Oslers disease)
Dieulatorys erosion
Causes of Haematemesis
and Melaena
Duodenum/jejunum
Peptic ulcer
Erosions/ Gastritis
Vascular malformations
Haemobilia
Polyps (including Peutz-Jeghers
syndrome and other polyposis syndromes)
Aorto-enteric fistula
Causes of massaive upper
gastrointestinal bleeding
Mallory
* Important causes of obscure UGIB
Aetiology of Non-Variceal Upper
Gastrointestinal Bleeding
Gastric ulcer, Gastric erosions, Haemorrhagic gastritis, Gastric
carcinoma, Gastric lymphoma, Leiomyoma, Gastric polyp, Hereditary
Stomach haemorrhagic telangiectasia, Dieulafoy lesion*, Gastric Antral
Vascular Ectasia (GAVE)*, Angiodysplasia*
1. Warna (colour)
2. Tanda Warna merah (red colour sign)
3. Bentuk (form)
4. Lokalisasi
Warna
Gambar 1
(CRS)
Cherry Red Spot
Gambar 2
(HCS)
Hemato Cystic Spot
Gambar 3
(DR)
Diffuse Redness
Gambar 4
Bentuk
Lm
middle
Li
inferrior
Lg
gastric
PENATALASANAAN AWAL
Anannesis & pemeriksaan fisis
Tanda vital, Jalan infus yg sangat besar
Selang nasogastrik Hb, Ht, trombosit,
hemostaisis
Hemodinamik stabil
Tidak ada perdarahan aktif Hemodinamik tidak stabil
Perdarahan aktif
Pengobatan empirik RESUSITASI
Cairan krostaloid, cairan koloid,
Transfusi darah, koreksi
faktor koagulasi
Hemodinamik stabil
Perdarahan berhenti Hemodinamik stabil
Perdarahan tetap berlangsung Obat Vasoaktif
Perdarahan berhenti Octreotide, Somat ostatin,
Vasopressin
Elektif Emergensi atau Dini
Endoskopi SCBA Endoskopi SCBA
heter probe
Argon_plasma_coagulation
Endoscopic Treatment For Non-variceal
Upper Gastrointestinal Bleeding
Injection
Adrenaline (1:10000)
Procoagulants (fibrin glue, human thrombin)
Sclerosants (ethanolamine, 1% polidoconal)
Alcohol (98%)