GASTROINTESTINAL

BLEEDING
OLEH: DARIUS REVIN GOZALI
 DEFINITIONS
 Upper GIB is that originating proximal to the ligament of Treitz; in
practice from the oesophagus, stomach and duodenum.
 Lower GIB is that originating from the small bowel and colon.
 Haematemesis ( and coffee-ground vomitus) is vomiting of blood from
the upper GI tract or occasionally after swallowing blood from a source in
the nasopharynx. Bright red haematemesis usually implies active
haemorrhage from the esophagus, stomach or duodenum. This can lead to
circulatory collapse and constitutes a major medical emergency.
 Coffee-ground vomitus refers to the vomiting of black material which is
assumed to be blood. Its presence implies that bleeding has ceased or has
been relatively modest.
 Melena is the passage of black tarry stools usually due to acute Upper GIB
but occasionally from bleeding within the small bowel or right side of the
colon.
 Hemtaochezia is the passage of fresh or altered blood per rectum usually
due to colonic bleeding. Occasionally profuse upper GI or small bowel
bleeding can be repsponsible
CAUSES OF UPPER
GIB
 PATOFISIOLOGI

 ULKUS PEPTIKUM
 Gangguan keseimbangan antara faktor asam dan pepsin
(mukus, bikarbonat, aliran darah) → mukosa dinding
lambung melemah →pecah → perdarahan
 Infeksi kuman Helicobacter Pylori → peradangan langsung
pada mukosa lambung dan duodenum → produksi asam
berlebih →membebani lapisan mukosa lambung →sakit
maag
 Obat-obatan anti inflamasi non steroid (NSAID), misalnya
aspirin, ibuprofen, naproxen, dan diklofenak → Konsumsi
dalam jangka waktu yang panjang → merusak lapisan
mukosa →ulkus peptikum
 PATOFISIOLOGI

• VARISES ESOFAGUS
Obstruksi sistem vena portal →
tekanan portal meningkat →
pelebaran pembuluh darah di
anastomosis → varises esofagus →
dinding varises yang rapuh bisa
pecah 10 → perdarahan
VARISES ESOFAGUS
 PATOFISIOLOGI

• MALLORY-WEISS TEAR

Kenaikan tekanan intragastrik

yang tiba-tiba atau prolaps
lambung ke esofagus → timbul
laserasi longitudinal di mukosa
lambung maupun esofagus →
sumber perdarahan
MALLORY-WEISS TEAR
DIAGNOSTIK

1. PERDARAHAAN  ANAMNESE  RIWAYAT

COMMON
 VOMITING (MENTAL)  MALLORY –WEISS TEAR ?
 HEARTBURN & REGURGITASI  REFLUX ESOFAGITIS ?
 DYSFAGIA & BB   MALIGNANCY PD ESOFAGUS ?
 MAKAN OBAT-OBATAN & ALKOHOL GASTRIC EROSIVE ?
ULKUS PEPTIKUM ?
 LIVER STIGMATA (CH)  VARICES BLEEDING ?
 PENYAKIT BERAT (DI ICU)  STRESS ULCER ?
RIWAYAT 
 BAB BERDARAH & KONSTIPASI & ABDOMINAL PAIN 
DIVERTIKULITIS

 BAB BERDARAH & MENETES NETES / MENGALIR 

HAEMMOROID

 BAB BERDARAH (+) DAN DIARE KRONIK  IBD

 BAB BERDARAH (+) USIA LANJUT & BB  & DIARE

KRONIK  MALIGNANCY

 BAB BERDARAH (+) & POST RADIASI  KOLITIS RADIASI

2. PEMERIKSAAN FISIK :
 Penilaian status hemodinamik & resusitasi
 Jaundice & Tanda2 liver stigmata & HT portal
 Bleeding diathesis : purpura, ekimosis, ptikiae
3. LAB
 RADIOLOGI

• USG • EMD FOTO (BA MEAL)

 PERD. VARISES ESOFAGUS  TUMOR ESOFAGUS
SIRHOSIS HEPATIS,
SPLENOMEGALI,  DIVERTIKEL ESOFAGUS
VENA PORTA/LIENALIS  TUMOR GASTER
>>  DIVERTIKEL DUODENUM
 TUMOR GASTER  ULKUS PEPTIKUM
 TUMOR PANKREAS
• FOTO POLOS • BA ENEMA (COLON IN LOOP)
ABDOMEN  TUMOR KOLON
 OBSTRUKSI KOLON/USUS  VOLVULUS
HALUS (TUMOR,  INVAGINASI
INVAGINASI, VOLVULUS)  DIVERTIKEL KOLON
 POLIP KOLON
 ENDOSKOPI
GASTROSKOPI KOLONOSKOPI

• TUMOR ESOFAGUS • TUMOR KOLON

• DIVERTIKEL ESOFAGUS • TUMOR REKTUM
• VARISES ESOFAGUS • POLIP KOLON
• TUMOR GASTER • DIVERTIKEL KOLON
• ULKUS PEPTIKUM • VOLVULUS KOLON
• DIVERTIKEL DUODENUM SIGMOID
Atas
TERIMA KASIH