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Bleeding from upper GI tract

Overview
  • Definition: Haemorrhage originating proximal to the ligament of Treitz, typically presenting as haematemesis (vomiting blood) or melaena (black, tarry stools).
Common Causes
  • Peptic Ulcer Disease: Gastric or duodenal ulcers due to NSAIDs or H. pylori.
  • Variceal Bleeding: Secondary to portal hypertension, often due to cirrhosis.
  • Gastritis or duodenitis.
  • Mallory-Weiss tear: Tear at the gastro-oesophageal junction.
  • Gastric erosions.
  • Gastric cancer.
  • Dieulafoy’s lesion: Abnormal large artery that erodes stomach wall.
Diagnostic Approach
  • History & Examination: Assess severity, possible etiology, and signs of shock.
  • Lab tests: Full blood count, coagulation profile, renal function, liver function tests.
  • Oesophagogastroduodenoscopy (OGD): First-line, allows direct visualisation and potential therapeutic intervention.
  • CT Angiography: In cases where OGD can’t localise bleeding.
Surgical Approach
  • Resuscitation: IV fluids, blood transfusion, correct coagulopathy, and monitor vitals.
  • For peptic ulcer bleeding uncontrolled by endoscopy:
    • Oversew of bleeding ulcer.
    • Vagotomy and antrectomy for recurrent or large ulcers.
  • For variceal bleeding:
    • Band ligation or sclerotherapy during OGD.
    • Transjugular intrahepatic portosystemic shunt (TIPS) if recurrent.
    • Surgical portosystemic shunts or oesophageal transection in select cases.
  • Preoperative Localisation: Ideally via OGD, or CT angiography if required.
  • Approach: Laparoscopic or open based on patient stability, surgeon expertise, and suspected pathology.
Post-operative Management
  • Monitor vital signs and haemoglobin levels.
  • Ensure adequate pain relief.
  • Proton pump inhibitors for ulcer disease.
  • Early mobilisation to prevent thromboembolic events.
  • Consider prophylactic antibiotics depending on procedure performed.
Key Points
  • Resuscitation and stabilisation are paramount in upper GI bleed.
  • OGD is essential for diagnosis, and often for treatment, of upper GI bleeds.
  • Surgical intervention is reserved for cases uncontrolled by endoscopic means or for certain specific pathologies.

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