UPPER

GASTROINTESTINAL
BLEEDING

ANKIT KUMAWAT
Roll no. 8
 GI BLEEDING

UPPER GI BLEEDING LOWER GI BLEEDING

- Above the ligament of Treitz - Below the ligament of Treitz
- Includes – - Includes –
Esophagus Small intestine
Stomach Colon
Duodenum
UPPER GI BLEEDING
• Causes –
Clinical features
• Hematemesis – Red with clots vomitus
Black ( coffee grounds ) vomitus
• Melena – Black, terry, foul smelling stools with
altered blood ( blood in upper GI for ≥ 14
hrs , one episode 3-5 days )
• Syncope
• Symptoms of Anemia
• Sometimes hematochezia - Maroon or bright red
stool
Management
• Non variceal bleeding
1. Intravenous Access
2. Initial clinical assessment –
• Define circulatory status
• Seek evidence for lever disease
• Identify comorbidities – cardiorespiratory ,
cerebrovascular, or renal diseases
3. Basic Investigations –
• complete blood count, blood urea and creatinine,
liver function test, prothrombin time, cross matching
Management
4. Resuscitation-
• Intravenous fluids should be given
• Blood should be transfused in active bleeding with
low BP and Tachycardia
• Comorbidities should be managed
5. Oxygen
6. Endoscopy
• Early Endoscopy ( within 24 hrs ) is recommended
• Endoscopy provides prompt diagnosis ,risk
stratification, hemostasis therapy.
Management
• It includes endoscopic clip or heat probe with
epinephrine injection.
• Combined with IV PPI 80 mg bolus, 8mg/hr drip to
stop active bleeding and rebleeding.

7. Surgery
• Peptic Ulcer treated by under running with or
without pyloroplasty
• Biopsy
• Partial gastractomy
Management
• Variceal Bleeding -
Suspected variceal bleeding

Start IV Trelipressin and antibiotics prophylaxis

Urgent Upper GI Endoscopy

Varices present Varices Absent

Variceal ligation,
Stop Trelipressin and
Sclerotherapy
treat as non variceal bleeding
or
Balloon tamponade
or
Emergency TIPSS
 Management
• Vasoconstrictor therapy-
Aim – To reduce portal inflow of blood and portal
pressure
• Drugs-
• Trelipressin – synthetic vasopressin analouge
Dose – 2mg IV 4 times daily until bleeding stops then
1mg IV 4 times daily for upto 72 hrs.
• Octreotide and Somatostatin
 Management
• Variceal ligation(banding)-
• Band ligation – sucking the varix in to cap placed
at end of endoscope and occlude them with a
tight band
• Sclerotherapy-
• Injection of sclerotic agent into varices may
arrest bleeding by producing thrombosis
• Agents – ethanolamine oleate , thrombin,
cyanoacrylate glue
Management
• Balloon Temponade
• Instrument- Sengstaken
Blackmore tube
• Initially gastric balloon is
inflated if bleeding
continues than
oesophageal balloon is
inflated
Management
• TIPSS (Transjugular Intrahepatic Portosystemic
stent Shunts)
• A stent is placed b/w Portal vein & Hepatic vein
within liver to provide portosystemic shunt and
reduce portal pressure
• It is done under radiological control via internal
jugular vein.
THANK YOU