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PDRHN Smba
PDRHN Smba
GASTROINTESTINAL
BLEEDING
DEFINITIONS
* HEMATEMESIS : is vomiting fresh red blood
A site of bleeding proximal to the duodenal-
jejunal junction ( Upper Treitz Ligament )
The Colour of vomitus depends on how long
the blood has been in the stomach
* Coffee ground vomiting is vomiting of altered
black blood
* Melaena is the passage of black tarry stools
Causes of Haematemesis
and Melaena
Oesophagus
Oesophageal Varices
Mallory-Weiss tear
Oesophageal carcinoma
Reflux oesophagitis
Foreign body
Causes of Haematemesis
and Melaena
Stomach
Peptic ulcer
Erosions/ Gastritis
Gastric varices
Portal hypertensive gastropathy
Gastric carcinoma
Lymphoma
Leiomyoma
Angiodysplasia (including Osler’s disease)
Dieulatory’s erosion
Causes of Haematemesis
and Melaena
Duodenum/jejunum
Peptic ulcer
Erosions/ Gastritis
Vascular malformations
Haemobilia
Polyps (including Peutz-Jeghers
syndrome and other polyposis syndromes)
Aorto-enteric fistula
Causes of massaive upper
gastrointestinal bleeding
Mallory
* Important causes of obscure UGIB
Gastrointestinal Bleeding
Gastric ulcer, Gastric erosions, Haemorrhagic gastritis, Gastric
carcinoma, Gastric lymphoma, Leiomyoma, Gastric polyp,
Stomach Hereditary haemorrhagic telangiectasia, Dieulafoy lesion*,
Gastric Antral Vascular Ectasia (GAVE)*, Angiodysplasia*
1. Warna (colour)
2. Tanda Warna merah (red colour sign)
3. Bentuk (form)
4. Lokalisasi
Warna
Gambar 1
(CRS)
Cherry Red Spot
Gambar 2
(HCS)
Hemato Cystic Spot
Gambar 3
(DR)
Diffuse Redness
Gambar 4
Bentuk
Lm
middle
Li
inferrior
Lg
gastric
Resuscitation
a. Mild or Moderate Bleed
* Pulse and blood pressure : N
* Hb > 10 mg/ml
* Without comorbidity
* Less than 60 years of age
b. Severe Bleed
Pulse > 100 beats/min
Sistolic blood pressure < 100
mmHg
Hb < 10 mg/ml
Aged > 60 years
Table 1. Hypovolaemic shock: symptoms, sign, and fluid replacement
Blood loss (ml) <750 750-1500 1500-2000 >2000
Blood loss (%bv) <15% 15-30% 30-40% <40%
Pulse rate <100 >100 >120 >140
Blood pressure Norma Norma Decreased Decreased
Pulse pressure Normal or increased Decreased Decreased Decreased
Respiratory rate 14-20 20-30 30-40 >35
Urine output >30 20-30 30-40 >35
Mental status Slightly anxious Mildly anxious Anxious & confused Confused & letargic
Fluid replacement Crystalloid Crystalloid Crystalloid & blood Crystalloid blood
heter probe
Argon_plasma_coagulation
Endoscopic Treatment For Non-variceal
Upper Gastrointestinal Bleeding
Injection
Adrenaline (1:10000)
Procoagulants (fibrin glue, human thrombin)
Sclerosants (ethanolamine, 1% polidoconal)
Alcohol (98%)