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Click to edit Master title style,.,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,G.I.Bleeding,Presented by:,Ahmed T.Al-Suwaidi,Mohamed S.Al-Hoqani,.,G.I.Bleeding Case,50 yrs,Pakistani,male,C/O:Bleeding/rectum&Abd.pain,Painless bleeding,1 yr excess bleeding,1 month,Black,4-5 times/day,little quant.,Abd.pain,Vomiting,1 week,.,G.I.Bleeding Case,M.H:,*no peptic ulcer disease,*no medications(NSAIDs),*no urinary symptoms,*not known DM,HPTN,IHD,*weight loss,.,G.I.Bleeding Case,O/E:,*Afebrile,*no pallor,*not dyspneaic,*no lymphoadenopathies,*no S.C.L.N,.,G.I.Bleeding Case,Vital Signs:,*Pulse:78 bts/min,*BP:130/80,*RR:18 br/min,Heart:NAD,Lung:NAD,.,G.I.Bleeding Case,Abd.:,*not distended,*no epigast.tenderness,*tender,firm,partly mobile mass at Rt lumbar region.,*spleen not palpable,*Lt lobe liver palpable,mildly tender,*bowel sounds present,.,G.I.Bleeding Case,PR:,*no enlarged piles,*no active bleeding,*no palpable mass,*no blood on finger,ECG,CBC,Sr Amylase,Bleeding profile,Abd X-ray,fecal loading ascending colon,.,G.I.Bleeding Case,Lab Results:,*Hb:14.1 g/dl*Plt:252*10,3,*Hypochromic,microcytic,*PT:17.3 sec*aPTT:35.4 sec,*Sr Amy:129 U/l,106 U/l,*Na,+,:140 mmol/l*K,+,:4.1 mmol/l,*BUN:17 mg/dl,.,G.I.Bleeding,Acute Vs Chronic,Acute Upper G.I.Bleeding:,Acute Lower G.I.Bleeding:,.,Acute Upper G.I.Bleeding,Haematemesis,Melaena,Site&Time,.,Acute U.G.I.Bleeding,Aetiology:,1.Drugs(Aspirin&NSAIDs),2.Alcohol,3.Chronic peptic ulceration(50%of GI hemorrhage),4.Others:reflux esophagitis,varices,gastric carcinoma,acute gastric ulcers&erosions.,.,Acute U.G.I.Bleeding,Clinical approach:,1.recent(24 hrs),then hospitalized.,2.if small amount,no immediate Tx,because CVS can compensate,3.85%stop bleeding during 48 hrs,4.history helps in diagnosing the cause of the hemorrhage,eg:long history of indigestion,or previous hem.from ulcers.,.,Acute U.G.I.Bleeding,Clinical approach:,5.factors include:,age(60+),amount of bld lost,continuing visible bld loss.,signs of chronic liver disease,classical clinical features of shoc,k,.,Acute U.G.I.Bleeding,Clinical approach:,6.liver disease,severe,recurrent bleeding (if from varices),7.splenomegaly,portal hypertension,.,Acute U.G.I.Bleeding,Immediate management:,*Emergency management:,History+exam.,Monitor:pulse&BP/30 min,Bld sample:haemoglobin,urea,electrolytes,grouping&cross-matching,I.v.access,.,Acute U.G.I.Bleeding,*Emergency management(cntd):,Bld transfusion in case of,1)shock 2)haemoglobin 1 ml/minute,.,Radionuclide scanning,Uses technetium-99m labeled red blood cells,.,Management,If source of colonic bleeding unclear perform a subtotal,colectomy,and end-,ileostomy,Acute bleeding tends to be self limiting,Consider selective mesenteric,embolisation,if life threatening,haemorrhage,If bleeding persists perform,endoscopy,to exclude upper GI cause,Proceed to,laparotomy,and consider on-table,lavage,an,panendoscopy,If right-sided,angiodysplasia,perform a right,hemicolectomy,If bleeding,diverticular,disease perform a sigmoid,colectomy,.,
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