UGIB

upper gastro intestinal bleeding

• upper GI tract is anywhere from the mouth to the
duodenojejunal junction or ligament of teritz

• abdominal pain may be

• visceral- diffused
• somatic- localised
• referred
causes
• Peptic ulceration.
• Mucosal inflammation (oesophagitis, gastritis, or
duodenitis).
• Oesophageal varices.
• Mallory–Weiss tear.
• Boerhaave syndrome
• Gastric carcinoma.
• Coagulation disorders (thrombocytopenia,
warfarin).
peptic ulcer disease
• the stomach is composed of 4 regions
• cardiac
• fundus
• body
• pylorus
• the layers of the stomach are
• mucosa
• sub mucosa
• muscularis
• serosa
• the gastric gland secretes gastric juice about
2-3L/day
• mucus cell-mucus
• parietal cell- intrinsic factor(absorption of B12) &
Hcl
• chief cell- pepsinogen and gastric lipase

• G cells in the pylorus secretes gastrin

• an ulcer is a disruption in the mucosa integrity of
the stomach/duodenum leading to local defect or
escavation due to inflammation
• peptic ulcer may be
• gastric- relieved by meal
• duodenal- 3hrs after meal
• meckel's diverticulum
• esophagus
• intestines
• PUD may be caused by
• helicobacter pylori
• NSAID- inhibition of cox 1, cox 2, prostaglandins
• chrons disease
• zollinger ellison syndrome
• smoking
• diet
• stress induced gastritis
esophageal varices
• extreme dilation of the
veins in the lower 3rd of
the esophagus due to
portal hypertension from
liver cirrhosis
• mallory weiss tear- tear in the area of the gastric
cardia due to forceful vomitting
• boerhaave syndrome- rupture of the oesophagus
due to forceful vomitting
• Gastric carcinoma.
• Coagulation disorders (thrombocytopenia,
warfarin).
presentation
• hematemesis
• melena stool
• hematochezia
• pallor
• signs and symptoms of shock
• cool clammy extremity
• tachycardia
• hypotension
• tachypnea
ivestigation
• blood- pcv,fbc, clothing profile( PT, PTT, INR), EUCr,
LFT, HBSg + anti HCV, GXM, RVS
• USS
• CXR
• Urinalysis
• endoscopy
• ecg
• PUD(h.pylori antigen, urea breath test, stool
monoclonial antibody)
history
• past gi bleeds
• ulcers
• how much blood was vomitted or stooled
• color of stool and duration
• history of liver disease
• vomitting
• drugs use
• diet
examination
• assess gcs
• capillary refil
• urine output
• examine for signs of liver disease
• abdominal pain
• tilt test- defficit in sbp of 20mmHg and dbp of
10mmHg or an increase of 20bpm in pulse
• rectal exam for melena
 management
• ABCs- supplemental o2, suction copiously if patient
cannot maintain airway, 2 large bore cannula for IV
• triple regimen- PPI(omeprazole, rabeprazole) 20mg,
clarithromycin 500mg, amoxicillin 1g/metronidazole
500mg bd for 7-14days
questions