Upper Gi Tract Bleeding Treatment

Causes Of Upper Gi Tract Bleeding

Causes Of Upper Gi Tract Bleeding Treatment: Initial management is to treat the shock in the line discussed for peptic ulcer haemorrhage.

Upper Gi Tract Indications for Surgery

1. Elderly patients with rebleed in the hospital
2. Rarity of blood groups
3. Spurting vessel in an endoscopy

Upper Gi Tract Surgery

• Surgical management of individual case has been discussed along with the concerned chapter. However, summary of the treatment is discussed in Table
• Thus, upper GI bleeding can occur due to various causes. However, acute erosive gastritis, chronic peptic ulcer and oesophageal varices are the three important causes of bleeding. Endoscopy is the investigation for the diagnosis of upper GI bleeding.
• Today, most of the upper GI bleeding is managed either in the form of injection sclerotherapy, laser coagulation, or with powerful H2 blockers or proton pump inhibitors. In appropriate cases, surgery is definitely indicated. Some common conditions which give rise to haematemesis are discussed in the following pages.

 

Dieulafoy Vascular Malformation

In this condition, an unusually large artery runs in the submucosa which lies in close contact with mucous membrane. Mucosal erosion precipitates the bleeding. In more than 80% cases, bleeding occurs within 6 to 8 cm from OG junction, at the lesser curvature. Endoscopy and endotherapy should be tried and if necessary, repeated also.

Sudden, massive, painless, recurrent haematemesis with hypotension is the presenting feature. Angiography to confirm the bleeding lesion and gelfoam embolisation must be tried first. Failure to achieve control of the bleeding— gastrotomy and wide excision of the lesion should be done.

Gastric Antral Vascular Ectasia (Gave)

It is an uncommon cause of chronic GI bleeding resulting in iron deficiency anaemia. It is also called watermelon stomach because of the presence of long red streaky area which are present in the stomach resembling a watermelon.

Acute Peptic Ulcer Subacute Complication of Peptic Ulcer: A small perforation of peptic ulcer which is sealed off by omentum may result in a residual abscess in one of the subphrenic spaces. It responds to conservative treatment. Otherwise, percutaneous drain¬age can be done with ultrasonographic guidance.

Watermelon Stomach (Gastric Antral Vascular Ectasia)

• Women in their 50s are commonly affected
• Antrum is commonly involved
• TIPSS in patients with portal hypertension
• Ectasia of antral vessels gives rise to UGI bleeding
• Red parallel stripes on the mucosal fold are characteristic
• Mucosal fibromuscular hyperplasia and hyalinisation are present
• Endoscopy is the investigation of choice
• Liver disease in 25% patients—cirrhotic men
• Other diseases—autoimmune connective tissue disorder may be associated with this—also Helicobacter pylori
• No control of bleeding—antrectomy may be required

Remember As Watermelon

Mallory-Weiss Syndrome

Aetiopathogenesis

• It occurs due to a tear in the gastric mucosa near the oesophagogastric (OG) junction.
• Also called partial thickness mucosal rupture.
• In Boerhaave syndrome, all layers are involved in a tear.

Acute Peptic Ulcer Conditions wherein Mallory-Weiss Tear is Seen

• Spirit or alcohol
• Pancreatitis
• Infarction—myocardial
• Renal failure
• Infection—cholecystitis
• Tumour—pregnancy

Remember as SPIRIT

Acute Peptic Ulcer Mallory-Weiss Syndrome Clinical Features

• The patient is usually a middle-aged male who, after consumption of alcohol, vomits the food contents first. During the course of vomiting because of straining and retching, a tear develops near the oesophagocardiac junction. Hence, the second vomitus contains blood.
• Sometimes, the bleeding can be so massive to produce hypotension and shock. In 90% of cases, the bleeding stops spontaneously.

Acute Peptic Ulcer Mallory-Weiss Syndrome Treatment

• Urgent resuscitation of haemorrhagic shock.
• Endoscopy to confirm the diagnosis—tear is seen in the lesser curvature.
• Ryle’s tube aspiration for 48-72 hours.
• Endotherapy—injection adrenaline 1:10,000 dilution is effective. If not, haemoclipping can be done.
• Multipolar electric coagulation
• When all other measures fail, gastrotomy (opening in the stomach) and under-running is necessary with 2-0 silk sutures.