UpperGIBleeding上消化道出血英文版.pptVIP

Upper GI Bleeding Tad Kim, M.D. UF Surgery tad.kim@surgery.ufl.edu (c) 682-3793; (p) 413-3222 Overview Definitions Initial Patient Assessment ABC Resuscitation Differential Diagnosis Identify the Source Stop the Bleeding History Physical Endoscopy Potential Complications Other diagnostics tests Role of Surgery Prevention Definitions Upper GI Bleeding = proximal to ligament of Treitz Hematemesis = vomiting blood This is diagnostic of upper GI bleeding Melena = passage of tarry or maroon stool Can be upper or lower (more commonly upper) Hematochezia = Bright red blood per rectum Usually characteristic of colonic hemorrhage Initial Patient Assessment Get to patient’s bedside, assess ABC Can the patient protect his airway? Does he need to be intubated? Is the patient hemodynamically unstable? Is he in hemorrhagic shock? 2 large bore IV, Bolus 2L fluids, Type Cross blood, send CBC Coags Place patient on O2 continuous monitor Place an NGT and lavage with NS To confirm if the bleeding source is upper GI Differential Diagnosis Peptic Ulcer Disease (PUD) 50% cases Gastritis / Duodenitis (15-30%) Subset due to NSAID use Varices from portal hypertension (10-20%) Mallory-Weiss tears at GE junction (5%) Esophagitis (3-5%) Malignancy (3%) Dieulafoy’s lesion (1-3%) Nasopharyngeal bleed – swallowed blood Other- Aortoenteric fistula, angiodysplasia, Crohn’s, hemobilia, hemosuccus pancreaticus History Physical History of prior ulcers, NSAID use, stress History of Helicobacter pylori treatment Alcohol abuse Retching - Mallory Weiss tear Alcoholic cirrhosis - portal hypertension and varices On Physical Exam, assess hydration Look for stigmata of cirrhosis portal HTN Management – Acute UGI Bleed Once again, make sure pt is resuscitated If anemic and symptomatic, give blood Place NGT/lavage (helps for endoscopy) Perform Upper endoscopy (EGD) For ulcers: if visible clot, visible vessel, or active bleeding, should cauterize/coagulate and inject sclerosing agent For acute variceal