UPPER GIT BLEEDING

Upper GIT bleeding
Dr. Ali Khairalla 2015 FICMS-FACS
Hematemesis and malena
•It is defined as bleeding from gastrointestinal tract proximal to lig. of Trietz
•It usually manifests as hematemesis or melena, and when sever, may even lead to hematochezia
•This affect –in recent years –the old people
•Allot of them associated with NSAID
•Despite different treatment modality the mortality is 5-10%

Principle of management
•1-the patient should be resuscitated
•2-the patient should be investigated
•3-the treatment according to the cause

The resuscitation
•IV should be established ( cannula, or central venous line)
•Catheterization of urinary bladder to monitor urine output
•Blood should be cross-matched
Bleeding peptic ulcer medical and minimal interventional treatment
•All patient receive oral PPI
Surgical treatment
Stress ulceration
•Occurs in patient with major injury or illness or undergone major surgery
•It is better to prevent this condition than treat it.
•Indications ;
1-patient who continues to bleed or re-bleed
2-visible vessel in the ulcer base , spurting , or clot in the base
3-elderly and unfit patient
4-patient required more than 6 units of blood
•Therapeutic Endoscopic devices for hemostasis (adrenaline injection , heater probe ,and clips )