Detailed DX and Mx of Upper and Lower GIbleed - souji

[ArchivalUser]

Pindi or anybody who is 100% sure about the topic. Please shed some light

[ArchivalUser]

APPROACH TO LOWER GI BLEEDING:

Initial evaluation & Resucitation ------------> Nasogastric tube aspiration ------->
(1) Aspirate shows copious bile & no blood( -----> next step Colonoscopy )
(2) Aspirate shows anything else other than bile( ----> next step EGD )


if EGD done ------>
(1) EGD confirms UGI source ------> treat as appropriate
(2) EGD Negative ------> proceed to Colonoscopy.


if Colonoscopy done ------->
(1) Source identified ------> treat as appropriate
(2) not possible to predict because of severity of bleeding ------> do Arteriography & surgical consultation.
(3) Colonoscopy negative ------> next step depends if hematochezia has ceased ? --------->
(a) if ceased -----> small bowel series done
(b) if not ceased ------> Arteriography.

[ArchivalUser]

Management follow this protocol:

1. Resuscitation and stabilization
2. Assessment of onset and severity of bleeding
--------------> after stabilization --------->
3. Diagnostic endoscopy
- Preparation for emergent upper panendoscopy
- Localization and identification of the bleeding site
- Stratification of the risk for rebleeding
4. Therapeutic endoscopy
- Control of active bleeding or high risk lesions
- Minimization of treatment-related complications
- Treatment of persistent or recurrent bleeding

[ArchivalUser]

1)Varices Rx
a)Octreotide----82% success rate
b)Endoscopic band ligation>90%, has replaced sclerotherapy which is 85% success rate
c)octreotide+endoscopic therapy-->95% success
d)Baloon tampnode or TIPS if the above fail.

==========rebleeding in next 5 days occur in pt with varices after band ligation or ====sclerotherapy,(almost 40% of cases),the next step in these situation is to do endoscopy again and do sclerotherapy or band ligation,if bleeding continue than do bloon temp or TIPS====

2)PUD
a)pharmacologic
=High dose PPI
=octrreotide
b)non pharma
=endoscopic therapy(inj,thermal or laser),
arteriography with infusion of vasopressin or embolization
surgery if pharma and endoscopic fail

3)mallory weiss
usuall stop spontaneosly,if not endoscopic therapy

4)esophagitis or gastritis
=PPI and H2

5)diverticuler disease
=== usuall stop spontaneosly
==Endoscopic therapy( eg epinnephrine inj),artrial vasopressin or embolization,surgery

6)angiodysplasia
==artrial vasopressin, endoscopic therapy,surgery

[ArchivalUser]

causes
upper Gi

1)oropharyngeal bleeding and epistaxis (swallowed blood)
2)Erosive esophagitis----10%
3)varices-------10%
4)PUD---50%
5)vasculer malformation---5%
6)neoplastic--esophgeal and gastric

[ArchivalUser]

thank you both of you for clearing my doubts. What source are you guys using as a study material? please guide

[ArchivalUser]

bump.

[ArchivalUser]

souji what materials did you use the first time for MCQ and did you do Dr red's workshop.
Hope you will answer my questions.

[ArchivalUser]

bump.