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  • A Patient With Hematemesis

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    justiceboakye
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    This document discusses the definition, history, examination, differential diagnosis, and management of gastrointestinal bleeding. It defines vomiting or passing of blood from sources above the ligament of Trietz. The history section outlines questions to ask patients about their bleeding episodes. The examination section lists signs to check for relating to potential causes like liver disease. Differential diagnoses include peptic ulcers, esophageal varices, cancers, and other less common conditions. Management involves initial evaluation, blood replacement, endoscopy within 24 hours to identify the source, and various endoscopic or medical treatments depending on the underlying cause such as portal hypertension.

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    This document discusses the definition, history, examination, differential diagnosis, and management of gastrointestinal bleeding. It defines vomiting or passing of blood from sources above the ligament of Trietz. The history section outlines questions to ask patients about their bleeding episodes. The examination section lists signs to check for relating to potential causes like liver disease. Differential diagnoses include peptic ulcers, esophageal varices, cancers, and other less common conditions. Management involves initial evaluation, blood replacement, endoscopy within 24 hours to identify the source, and various endoscopic or medical treatments depending on the underlying cause such as portal hypertension.

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    Attribution Non-Commercial (BY-NC)
    Als PPTX, PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    41 Ansichten12 Seiten

    A Patient With Hematemesis

    Hochgeladen von

    justiceboakye
    This document discusses the definition, history, examination, differential diagnosis, and management of gastrointestinal bleeding. It defines vomiting or passing of blood from sources above the ligament of Trietz. The history section outlines questions to ask patients about their bleeding episodes. The examination section lists signs to check for relating to potential causes like liver disease. Differential diagnoses include peptic ulcers, esophageal varices, cancers, and other less common conditions. Management involves initial evaluation, blood replacement, endoscopy within 24 hours to identify the source, and various endoscopic or medical treatments depending on the underlying cause such as portal hypertension.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Als PPTX, PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    von 12

    Osei Sarfo-Kantanka

    Definition & related terms


    History and Examination Clinical Presentation

    Differential diagnosis
    Management

    Definition & related terms


    Vomiting of gross blood derived from any source

    proximal to ligament of trietz Hematochezia Melaena

    History
    i) Was it blood: if so was it coughed vomited? ii) What form and severity of blood loss iii) What is the state of health immediately before and

    after bleeding? iv) Is there rectal blood loss? v) What symptoms accompany the blood loss vi) What are the possible causes of bleeding Is it benign or malignant? Is it from cirrhosis alcoholic ????how long Effect on other systems GIT, RS, CVS, CNS, GUS

    PMHx

    DHx SHx

    Duodenal ulcer Gastric ulcer Liver cirrhosis Arthritis Any recent operation DVT & PE As above Alcohol intake Smoking

    Examination
    General state Anaemia, dehydration? Lymphadenopathy? Signs of Liver disease spider naevi, palmer erythema, gynaecomastia, clubbing, testicular atrophy Abdomen distended with ascitis, hepatomegaly, splenomegaly PR malaena stools, blood stain stools, rectal masses.

    Portal hypertension
    Hepatic portal vein, splenic vein, celiac trunk, superior

    mesenteric, inferior mesenteric veins. Portal pressure: Portal vein and hepatic vein >5mmHg Portosystemic anastamosis left gastric vein and azygol vein esophageal varix

    Peptic Ulcer: Breach in epithelial surface of esophageal, stomach, duodenum H pylori infection NSAID alcohol Smoking Stress Zollinger-Ellision syndrome

    OTHER CAUSES Esophagitis Eesophageal Ca Inflammatory bowel disease Mallory Weiss tear Hypertensive gastropathy Gastric Carcinoma Angiodysplasia Dieulafoy lesion Hemangioma Deodenitis Coagulopathy Aorta -enteric fistula

    Management
    Initial evaluation A B C Mild bleed normal BP, normal pulse, normal respiration, state of mucosa ,< 15% Severe bleed weak, BP, orthostatic hypotention? Tachypnoeic, an uric, > 15% Large ball cannula CBC, PT, INR, Urea, Creatinine, liver enzymes Grouping and crossmatching Normal saline Blood replacement 15 31 PCV

    Endoscopy (within 24 hrs) Peptic ulcer IV PPI Topical treatment Injection treatment Mechanic treatment Thermal treatment Surgical treatment

    Portal hypertenson
    Sclerotherapy
    Baloon tamponade Band ligation

    Propranolol
    IV octreotide IV telipressin

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