The surgical management of acute upper gastrointestinal. Often, the location of the bleeding lesion in the upper gi tract is signaled by the patients presentation with hematemesis. There has been tremendous advancement in pharmacological and endoscopic. Design plans for the prevention of upper gi bleed ing caused by commonly associated risk factors. Upper gastrointestinal bleeding during antiplatelet therapy dr. Upper gastrointestinal and small bowel series synonymacronym. Upper gi bleeding has mortality changed with advancements. The study was prospective, populationbased and consisted of all patients. Mortality with upper gastrointestinal bleeding and. Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate.
In patients who receive lowdose asa and develop acute ulcer bleeding, asa therapy should be restarted as soon as the risk for cardiovascular complication is thought to outweigh the risk for bleeding. Fookhong ng senior medical officer, department of medicine and geriatrics, ruttonjee hospital, hong kong mbbs, b sc, frcp, fhkcp, fhkam medicine dr. Upper gastrointestinal bleeding acute management geeky medics. Variceal bleeding recommendation strength of evidence classification.
Patients with acute upper gastrointestinal gi bleeding commonly. Aug 12, 2019 acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Combining epinephrine injections with human thrombin 600 iu. Clinical guidelines suggest avoiding use of certain drugs. There are only few recent epidemiological surveys regarding acute upper gastrointestinal bleeding. Upper gastrointestinal bleeding ugib has a wide spectrum of presentations which. Upper gastrointestinal bleeding ugib is one of the most common gi medical emergencies, which all gi units deal with everyday.
Approach to upper gastrointestinal bleeding in children. If you notice signs of an upper gi bleed, then you. Upper gastrointestinal hemorrhage, gastrorrhagia, upper gi bleed, ugi bleed. Ugi abbreviation stands for upper gastrointestinal bleeding. Upper gastrointestinal bleeding is a serious condition that requires medical treatment. Acute upper gastrointestinal bleeding is an important emergency situation. Upper gastrointestinal bleeding is a common medical.
Bleeding that requires more than three units of blood in 24 hours usually demands operative. Variceal hemorrhage results from complications of endstage liver disease, and nonvariceal bleeding is associated with peptic ulcer disease pud or other causes of ugib. Patients present with hematemesis bloody or coffee ground emesis or melena, although hematochezia can occur in the context of a major bleed and is typically associated with hemodynamic insta bility. Diagnosis and management of upper gastrointestinal bleeding. Nonvariceal upper gastrointestinal bleeding remains a common clinical problem globally. How to identify upper gastrointestinal bleeding symptoms. This concern can often be resolved by passing a nasogastric tube if aspiration reveals bile, the bleeding site is below the duodenojejunal junction. Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper gastrointestinal hemorrhage. At endoscopy a full inspection of the foregut must be undertaken. What is the abbreviation for upper gastrointestinal bleeding.
Acute gastrointestinal bleeding is a potentially lifethreatening abdominal emergency that remains a common cause of hospitalization. Mar 01, 2012 upper gastrointestinal bleeding causes significant morbidity and mortality in the united states, and has been associated with increasing nonsteroidal antiinflammatory drug use and the high. Since the bleed area will be trimmed, there should be no text or other important information in the bleed area. Mar 29, 2019 how to identify upper gastrointestinal bleeding symptoms. Dc and avoid all meds that can cause or worsen gi bleed anticoagulants, antiplatelets, nsaids. Clopidogrelassociated gi bleeding was significantly more common in patients with a history of gi bleeding associated with the use of aspirin or h.
The esophagus, stomach, and duodenum first part of the small intestine are made visible on xray film by a liquid suspension. The upper gastrointestinal gi series is a radiological examination of the esophagus, stomach, and small intestine after ingestion of barium sulfate, which is a milkshakelike, radiopaque substance. Gastrointestinal gi bleeding somchai leelakusolvong, m. Balloon tamponade should be used as a temporizing measure maximum 24 hours in patients with uncontrollable bleeding for whom a more definitive therapy e. This includes the esophagus and stomach and may include the small bowel, if requested by your physician.
Diagnosis and management of upper gastrointestinal bleeding in. Presence of blood clots in the stool make ugi source less likely. The role of endoscopy in the management of acute non. Ugi bleedabove the ligament of treitzesophagusstomachduodenal bulb2nd and 3rd portion of duodenum. American college of gastroenterology guideline on the management of.
Causes of upper gastrointestinal bleeding in adults uptodate. Devise a plan to effectively manage acute gi bleeding and optimize treatment responses in the individual patient. Upper gastrointestinal bleed ugib causes significant morbidity and mortality the world over. Current guidelines recommend a regimen of an intravenous iv ppi 80mg. Management and prevention of upper gi bleeding accp. Upper gastrointestinal bleeding ugib has a major impact on patients. Upper gastrointestinal bleeding during antiplatelet therapy. Documents acute upper gastrointestinal bleeding in over 16s. Evidencebased recommendations on acute upper gastrointestinal gi bleeding for people over 16. Predicting outcomes of upper gastrointestinal bleeding.
Upper gastrointestinal hemorrhage the word upper implies that the source of bleeding is in the esophagus, stomach or duodenum. Looks at results and at what could affect the test. Peptic ulcer bleeding causes more than 60 percent of cases of upper gastrointestinal bleeding, whereas esophageal varices cause approxi mately 6 percent. Can be categorized as either variceal or nonvariceal. In the absence of hematemesis, an upper source for gi bleeding is likely in the presence of at least two factors among.
Populationbased epidemiology data are important to get insight in the actual healthcare problem. Information from 61,067 cases and 5,001 deaths was available, with more than four times as much information on mortality in patients with upper gastrointestinal bleeding or perforation published during the period between 1997 and 2008 than previously table 1. June 2012 nice clinical guideline 141 guidanceukcg141 nhs evidence has accredited the process used by the centre for clinical practice at nice to produce guidelines. Patients with upper gi bleeding should generally undergo endoscopy within 24 hours of admission, following resuscitative efforts to optimize hemodynamic parameters and other medical problems. Approach to upper gastrointestinal bleeding thomson. Upper gastrointestinal ugi bleeding arising proximal to the ligament of treitz in the distal duodenum commonly presents with hematemesis vomiting of red blood or coffee groundlike material andor melena black, tarry stools. Definition upper gi ugi bleeding is generally defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. The patient who has sustained an ugi hemorrhage typically exhibits features of hypovolemia or hypovolemic shock. It has an incidence of 103170 per 100,000 population each year,1, 2 with a reported mortality of 711% in patients admitted to hospital and 2633% in those developing bleeding whilst an inpatient for other reasons. Upper gastrointestinal bleeding ugib is a potentially lifethreatening condition that needs to be rapidly recognised and managed effectively, with the involvement of appropriate senior support. Variceal is a complication of end stage liver disease. Upper gi ugi bleeding is generally defined as bleeding that. Introduction upper gastrointestinal bleeding ugib is a poten.
Despite changes in management, mortality has not significantly improved over the. Endoscopic advances in the management of nonvariceal upper. Pdf management of acute upper gastrointestinal bleeding. If so, share your ppt presentation slides online with. This includes the esophagus and stomach and may include. See upper gastrointestinal bleeding for clinical treatment page. Siuyin wong medical officer, department of medicine and geriatrics. Gastric radiography, stomach series, small bowel study, upper gi series, ugi. Upper gastrointestinal bleeding ugib is a common medical condition that results in substantial morbidity, mortality, and medical care cost. Lgi bleedbelow the ligament of treitzsmall bowelcolon. However, in patients with clinical evidence of rebleeding following successful initial endoscopichemostasis, esge recommends repeat upper endoscopy with hemostasis if indicated. Rebate application must be postmarked within 180 days of purchase and by june 30, 2024 and must be accompanied by proof of purchase legible copy of dated and itemized.
Ugi esophageal varices, malloryweiss tear, dieulafoys lesion, pud, esophagitis, neoplasm, aortoenteric fistula if hx of aaa repair. Upper gastrointestinal bleeding, lower gastrointestinal. An upper gastrointestinal ugi series looks at the upper and middle sections of the gastrointestinal tract. Ugi abbreviation for upper gastrointestinal series. This will allow identification of nonvariceal causes of haemorrhage, which occur in 10% of cases, and those who may be bleeding from gastric varices or portal hypertensive gastropathy. The barium is often combined with gasmaking crystals. Upper gastrointestinal bleeding is defined as bleeding from a source proximal to the ligament of treitz and can be categorized as either variceal or nonvariceal. While non variceal bleeding associated with peptic ulcer disease or other causes of ugib. Obtain surgery and interventional radiology consultation for any largescale bleeding.
A ugi upper gastrointestinal series refers to an xray of the upper digestive tract. Management of non variceal upper gastrointestinal bleeding elsevier. Search strategies used for the upper gastrointestinal bleeding guideline were. Feb 01, 2014 upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Jan 29, 20 the authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding augib and to examine the role of drugs potentially associated with augib. Upper gastrointestinal bleeding ugib is defined as a clinically significant bleeding no fixed amount of blood from the gastrointestinal gi tract above the ligament of treitz anatomical landmark between the duodenum and jejunum which includes the esophagus, stomach, and duodenum.
Acute upper gastrointestinal bleeding augib is a common reason for hospitalization, with reported incidence ranging from 36 to 172100,000 inhabitants per year 14,614. Nasogastric lavage may be helpful if the source of bleeding is unclear upper or lower gi tract or to clean the stomach prior to endoscopy. Upper gastrointestinal series ugi an upper gastrointestinal series ugi is a radiographic xray examination of the upper gastrointestinal gi tract. The standards of practice committee of the american society for gastrointestinal endoscopy asge prepared this text. Upper gastrointestinal bleeding occurs above the ligament of treitz as a result of duodenal or gastric ulcers, gastric or esophageal varices caused by cirrhosis of the liver, or malloryweiss syndrome. Bleed is a printing term used to indicate the area with a background image that will be trimmed off after the file is printed and cut to final size. Consensus guidelines recommend endoscopy within 24h. Common use to assess the esophagus, stomach, and small bowel for disorders related to obstruction, perforation, weight loss, swallowing, pain, cancer, reflux. Ugi tract bleeding free download as powerpoint presentation.
Upper gastrointestinal bleeding ugib is defined as bleeding derived. Rapid filling of the stomach with blood will usually result in emesis. Guidelines for endoscopic management of nonvariceal. Results showed a significant and important reduction in mortality over time, by an. In patients with previous ulcer bleeding who require cardiovascular. Immediate measures are focused at restoring intravascular volume and maintaining. The role of endoscopy in the management of acute nonvariceal upper gi bleeding this is one of a series of statements discussing the use of gi endoscopy in common clinical situations. Literature search strategies acute upper gastrointestinal bleeding. Approach to acute upper gastrointestinal bleeding in adults. In this multicenter prospective study, researchers compared scoring systems for their ability to predict clinical outcomes of ugi bleeding, including survival. Ugib is broadly categorized into variceal and non variceal bleeding. Discusses test that uses xrays to find problems in the esophagus, stomach, and small intestine.
A comprehensive collection of osce guides to common clinical procedures, including stepbystep images of key steps, video demonstrations and pdf mark schemes. Accreditation is valid for 5 years from september 2009 and applies to guidelines. Acute upper gastrointestinal bleeding augib is one of the commonest emergency admissions to gastroenterologists. Bleeding that requires more than three units of blood in 24 hours usually demands operative measures. Blood may be observed in vomit or in altered form as black stool. Upper gastrointestinal bleeds ugi bleeds aetiology of upper gi ugi bleeds peptic ulcer disease oesophageal, gastric or duodenal ulcers prevalence 4% of the population due to h. This distinction becomes crucial as the management strategies are different for variceal and nonvariceal bleeding. Ugi bleeding is identified by a history of dark stools, nausea or abdominal pain, and positive stool guaiac test. The test uses barium contrast material, fluoroscopy, and xray. Presentations, lab findings and diagnostics the diagnosis of upper gi bleeding is assumed when hematemesis is documented. Div of gastroenterology, dept of medicine, siriraj endoscopy center email address. Before the test, you drink a mix of barium barium contrast material and water. Although the incidence of augib has been rather extensively studied, there are only three prospective populationbased studies reporting on the incidence in the last decade.
Documents acute upper gastrointestinal bleeding in over. Upper gastrointestinal bleeding ugib is defined as bleeding derived from a source proximal to the ligament of treitz. Approach to upper gastrointestinal bleeding upper gi bleeding is the most common complication of peptic ulceration and portal hypertension. In the case of failure of this second attempt at he. Mar 16, 20 presentations, lab findings and diagnostics the diagnosis of upper gi bleeding is assumed when hematemesis is documented. Search constructed by combining the columns in the following table using the. Management of acute upper gastrointestinal bleeding. It commonly presents with hematemesis vomiting of blood or coffee groundlike material andor melena black, tarry stools. Management of upper gastrointestinal bleeding by an internist. Upper gastrointestinal ugi bleeding is associated with substantial mortality in as many as 14% of patients. Management of upper gastrointestinal tract bleeding slcog. Diagnosis and management of nonvariceal upper gastrointestinal. Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum.
Upper gastrointestinal bleeding acute management geeky. In an analysis of the 3 studies combining thermal methods with injection 37,38. Epidemiology of acute upper gastrointestinal bleeding. Diagnosis 1 questions to ask in history any hematemesis, coffeeground emesis, melena, or hematochezia.
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