Upper gastrointestinal bleeding

Posted by e-Medical PPT
Upper gastrointestinal bleeding refers to hemorrhage in the upper gastrointestinal tract. The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon.Upper GI bleeds are considered medical emergencies, and require admission to hospital for urgent diagnosis and management. Due to advances in medications and endoscopy, upper GI hemorrhage is now usually treated without surgery.Patients with upper GI hemorrhage often present with hematemesis, coffee ground vomiting and melena,.he presentation of bleeding depends on the amount and location of hemorrhage.Patients may also present with complications of anemia, including chest pain, syncope, fatigue and shortness of breath.

The causes for upper GI hemorrhage include the following:
* Esophageal causes:Esophageal varices,Esophagitis,Esophageal cancer,Mallory-Weiss tear
* Gastric causes:Gastric ulcer,Gastric cancer,Gastric varices,Gastric antral vascular ectasia,Dieulafoy's lesions
*Duodenal ulcer
*Vascular malformation, including aorto-enteric fistulae.
*Severe superior mesenteric artery syndrome
Emergency treatment for upper GI bleeds includes aggressive replacement of volume with intravenous solutions, and blood products if required. As patients with esophageal varices typically have coagulopathy, plasma products may have to be administered. Vital signs are continuously monitored.Early endoscopy is recommended, both as a diagnostic and therapeutic approach, as endoscopic treatment can be performed through the endoscope.


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