Upper GI Haemorrhage UGIH

1
Upper GI Haemorrhage(UGIH)
2
Ligament of Treitz
3
Definition of UGIH

• UGIB is bleeding derived from a source proximal
  to the Ligament of Treitz.
• Signifies GIT bleeding due to a cause above the
  Ligament of Treitz.
• Also known as nonvariceal upper gastrointestinal
  haemorrhage .

4
Some Related TermsHaematemesis

• Is the vomiting of blood.
• It indicates that the bleeding is from a cause
  proximal to the (LOT).
• The colour of the vomited blood is dependent on
  the CON. Of HCL and its admixture with the blood
  .If the vomiting occurs soon after the UGIB ,
  then haematemesis will be bright red in colour.
  IF there is a time lag then haematemesis will be
  dark red brown or black .HOW does this happen?

5
Melaena

• The passage of black and tarry stools.
• Usually due to UGIH.
• It results from more then 60-100 ml of blood with
  moderate transit time.
• Can be a result of LGIH if the GI transit time
  was sufficiently prolonged to about 8hrs.

6
Haematochezia

• The passage of fresh blood per rectum due to
  bleeding from the lower GIT.
• Rarely due to UGIB. This is possible in tow
  situations .
• CAN YOU FIGURE IT OUT ?

7
Causes of UGIH

• Duodenal ulcer (commonest cause).
• Gastric ulcer
• Gastritis .
• The above 3 account for 85 of UGIH
• Other rare causes are
• Mallory-Weiss tear.
• Boerhaave syndrome.
• Esophageal Varices.
• Aortoenteric fistula.
• Neoplasm, Haemobilia DRUGS what are they?
• Portal hypertensive gastropathy.

8
Symptoms and sings

• Hematemesis - 40-50
• Melena - 70-80
• Hematochezia - 15-20
• Syncope - 14.4
• Presyncope - 43.2

9
Symptoms and sings

• Dyspepsia - 18
• Epigastric pain - 41
• Heartburn - 21
• Diffuse abdominal pain - 10
• Dysphagia - 5
• Weight loss - 12
• Jaundice - 5.2

10
Probable Source of GI Bleeding Within the Gut
11
Peptic Ulcer (PU)

• A break in the epithelial surface (i.e.
  ulceration) of the oesophagus, stomach or
  duodenum .
• PU includes
• Duodenal ulcer.
• Gastric ulcer.
• Duodenal ulcer is more common.

12
Common parts involved
13
Common causes

• Infection with H.pylori.
• NSAID and the usual suspects
• (Alcohol ,smoking, stress)
• Imbalance between the aggressive and protective
  mechanisms.
• Acid hypersecretion due to increase number of
  parital cells or as seen in Zollinger-Ellison
  syndrome).

14
Clinical Features (DU Type 2 GU)

• M gt F ,20-50 yrs.
• Epigastric pain during fasting (hunger pain),
  relieved by food and Antacids.
• Boring back pain if ulcer is penetrating
  posteriorly.
• Haematemesis from ulcer penetrating GD artery
  posteriorly.
• Can lead to peritonitis if ulcer occurs
  aneriorly.
• Can lead to pyloric stenosis. How ? And what are
  the signs ?

15
Type 1 GU

• MgtF 31 , 50 yrs.
• Epigastric pain induced by eating.
• Weight loss.
• Nausea and vomiting.
• Anaemia from chronic blood loss.

16
Investigations

• CBC to check for Anaemia.
• U E.
• Faecal occult blood.
• OGD
• Barium meal
• Urease breath test.

17
Management (Medical)

• In chronic DU eradication of H.pylori.
• General management
• Avoid smoking and food that cause pain.
• Antacids for symptomatic relief.
• H2 blokers like ..

18
Management (surgical)

• Only indicated for failure of medical treatment
  and complications.
• Elective for DU Vagotomy.
• Elective for GU Billroth 1 gastrectomy.
• Perforated D or GU Closure of the perforation
• Haemorrhage endoscopic control by sclerotherapy
  , undersewing bleeding vessel.

19
REFERENCES

• Essentials of surgery by Sanjay AZAD.
• www.emedicine.com
• Clinical surgery by cuschieri.

20
(No Transcript)
21
(No Transcript)