Anatomy, causes, complications and management of upper GI bleeding

1. Upper Gastrointestinal
Bleeding
Kritika Singh

2. Definitions
Upper GIB is that originating proximal to the
ligament of Treitz; in practice from the oesophagus,
stomach and duodenum.
Haematemesis (and coffee-ground vomitus) is vomiting
of blood from the upper GI tract which is rapid &
profuse. This can lead to circulatory collapse and
constitutes a major medical emergency.
Melaena is the passage of black tarry stools usually due
to acute upper GIB but occasionally from bleeding
within the small bowel or right side of the colon.
Hemtaochezia is the passage of fresh or altered blood
per rectum usually due to colonic bleeding.
Occasionally profuse upper GI or small bowel bleeding
can be responsible.

3. ANATOMY

4. Causes of UGIB GI GIB

10. • A study was done in Western India & the patients were selected randomly
(total=50)
• Most common cause of UGIB in present study was :-
1. Acute erosive gastritis (34%)
2. Portal HTN (24%)
3. Peptic ulcer (22%)
• UGIB is 5 times more common than LGIB.
• Males are affected twice as much as compared to females.
• Out of all the patients, 10-15% shows worst prognosis.
• A risk scoring system have been developed to stratify risk of bleeding
endoscopic therapy or a poor outcome.

11. BLATCHFORD SCORE
# Advantage ?
- it may be used before endoscopy to predict the need for
intervention to treat bleeding.
# Scoring ?
- Low score (2 or less) are associated with very low risk of
adverse outcome.
And Blatchford score is also known as Glasgow Blatchford
Scoring (GBS).

13. Rockall Score

14. Risk Factors
•Age > 50 years
•Use of NSAIDS, such as aspirin, naproxen
•Excessive alcohol intake
•Smoking or chewing tobacco
•Any serious illness
•Radiation
•Excess acid production

15. Complications of GIB
ANEMIA
SHOCK

16. CHEST PAIN

20. • GainIV access withlarge bore cannula.
• Basic investigations-bloodcount,routine biochemistry,cross matchblood.
• Hourly measurementsof BP ,pulse and urine output.
• IV colloids or crystalloids–pt with hypotensionand tachycardia.
• Transfusewith blood (if BP is low and patientis activelybleeding).
• Endoscopy for diagnosis& Rx
• IV PPItherapyfor bleedingpepticulcer
Emergency management of acute non-
variceal upper GI haemorrhage

21. • 0.9 % saline
• Vasopressor
• Prophylactic antibiotics
• Emergency endoscope
• Variceal-band ligation
• Proton pump inhibitor
• Phosphate enema/lactulose enema
Emergency management of
variceal bleeding

22. 1 . ENDOSCOPIC THERAPY with
* Bipolar electro coagulation
* Heater probe
* Injection therapy
- Absolute alcohol
- 1:10000 adrenaline
- Clips
2 . High dose constant infusion of iv
PPI E.g. Omeprazole – 80 mg
bolus & 8 mg/hr infusion

23.  Eradication of H.Pylori infection
 Discontinue NSAIDS & acids
 If NSAIDS have to be used, use along with PPI
 Use selective COX-2 inhibitors like Coxib or
traditional NSAIDS + Coxib
 Coxib + PPI : further significant decrease in
ulcers and recurrent bleeding.

24.  Mostly bleeding stops
spontaneously ( Recurrence is
only 0-7 % )
 Endoscopic therapy is only for
actively bleeding Mallory-
Weiss tear.
 Angiographic therapy with
embolisation & operative
therapy with over sewing of
tear can be done ( but only
required rarely )

25. I. Vasoconstrictors (somatostatin, octreotide ,
terlipressin) iv terlipressin infusion at 2 mg every6
hours, generalised vasoconstriction leading to
decreased blood flow to venous system.
III.
II. Balloon tamponade – Triple lumen or Four lumen
tube with oesophageal and gastric balloons.
(Always intubate the patient prior to this procedure
to prevent aspiration)
Endoscopic variceal liagation[Band ligation]
IV. Sclerotherapy
V. Antibiotic therapy

26.  Avoiding the long-term use of
alcohol, NSAIDs, coffee, high-
fat foods and drugs
 Reducing stress
 Antacids, H2 blockers, PPIs
 Triple therapy: 2 antibiotics + 1
PPI is commonly used to treat
H. Pylori related gastritis