GI BLEED.pptx- introduction, definition, types, causes, signs and symptoms, diagnostic evaluation and it's management

Gastrointestinal bleeding or gastrointestinal hemorrhage is a form of hemorrhage in the gastrointestinal tract, from the pharynx to the rectum. The degree of bleeding can range from nearly undetectable to acute or massive, life-threatening bleeding.

1. Gi bleeding By: Saumya Yadav Nursing tutor

2. DEFINITION Gastrointestinal bleeding or gastrointestinal hemorrhage is a form of hemorrhage in the gastrointestinal tract, from the pharynx to the rectum. The degree of bleeding can range from nearly undetectable to acute or massive, life-threatening bleeding.

3. Types of GI bleed Upper GI bleeding : Bleeding in the esophagus, stomach, or the beginning of small intestine, Lower GI bleeding : Bleeding in the small intestine, large intestine, rectum, or anus. Frank (obvious) bleeding : Active bleeding that can be easily seen. For example, vomit blood. Occult (hidden) bleeding : Slow bleeding that cannot be seen easily. Tests may be needed to find occult bleeding. Acute GI bleeding: Blood loss that is new or sudden, and lasts for only a short time. Chronic GI bleeding : Blood loss that has been going on for a long time, or that comes back often.

4. Causes Peptic ulcers : Helicobacter pylori (H. pylori) infections and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are common causes of peptic ulcers. Esophageal varices : Varices, or enlarged veins, located at the lower end of the esophagus may rupture and bleed massively. Cirrhosis is the most common cause of esophageal varices. Esophagitis : Gastroesophageal reflux disease (GERD) is the most common cause of esophagitis.

5. Causes Mallory-Weiss tears : These tears in the lining of the esophagus usually result from vomiting. Increased pressure in the abdomen from coughing, hiatal hernia, or childbirth can also cause tears. Gastritis : NSAIDs and other drugs, infections, Crohn's disease, illnesses, and injuries can cause gastritis, inflammation and ulcers in the lining of the stomach. Benign tumors and cancer . A benign tumor is an abnormal tissue growth that is not cancerous. Benign tumors and cancer in the esophagus, stomach, or duodenum may cause bleeding.

6. Sign and symptoms of GI bleed Signs of bleeding in the upper digestive tract include: Bright red blood in vomit. Vomit that looks like coffee grounds. Black or tarry stool. Dark blood mixed with stool. Stool mixed or coated with bright red blood.

7. Sign and symptoms of GI bleed Signs of bleeding in the lower digestive tract include: Black or tarry stool. Dark blood mixed with stool. Stool mixed or coated with bright red blood. Sudden, severe bleeding is called acute bleeding

8. Sign and symptoms of GI bleed If acute bleeding occurs, symptoms may include: Weakness Dizziness or faintness Shortness of breath Crampy abdominal pain Diarrhea Paleness

9. Sign and symptoms of GI bleed Signs and symptoms of losing too much blood may include: Chest pain, or a feeling like heart is beating too fast. Extreme tiredness. Dizziness or fainting, especially after moving from a sitting or lying position. Pale skin or gums, and sweaty or clammy skin. Dry mouth, increased thirst, or passing less urine. Feeling confused or short of breath.

10. Diagnostic Evaluation History collection Physical examination Rectal examination Stool for occult blood Blood test for haemoglobin level, coagulation profile ABG and Electrolyte

11. Diagnostic Evaluation Endoscopy Endoscopy is the most common method for finding the source of bleeding in the digestive tract. An endoscope is a flexible tube with a small camera on the end. The doctor inserts the endoscope through the patient's mouth to view the esophagus, stomach, and duodenum. This examination is called esophagogastroduodenoscopy (EGD).

12. Diagnostic Evaluation Enterostomy Enterostomy is an examination of the small intestine. Because traditional endoscopes cannot reach the small intestine, special endoscopes are used for enterostomy. This Procedures Include: Push enterostomy : A long endoscope is used to examine the upper portion of the small intestine. Double-balloon enterostomy : Balloons are mounted on the endoscope to help the endoscope move through the entire small intestine.

13. Diagnostic Evaluation Capsule endoscopy : The person swallows a capsule containing a tiny camera. The camera transmits images to a video monitor as the capsule passes through the digestive tract. This procedure is designed to examine the small intestine. Barium X-rays : Barium is a contrast material that makes the digestive tract visible in an X-ray. Liquid containing barium is either swallowed or inserted into the rectum. Barium X-rays are less accurate than endoscopy and may interfere with other diagnostic techniques.

14. Diagnostic Evaluation Radionuclide scanning : A small amount of radioactive material is injected into the person's vein. A special camera, similar to an X-ray machine, can detect this radiation and create images of blood flow in the digestive tract. Radionuclide scanning is sensitive enough to detect very slow bleeding, but it is not as accurate as other procedures. Angiography: A dye is injected into the person's vein to make blood vessels visible in X-ray or computerized tomography (CT) scans. Dye leaks out of the blood vessels at the bleeding site.

15. Medical Management Antibiotics: ampicillin, amoxycillin Proton Pump Inhibitors: pantoprazole, rabeprazole Vasoconstrictors: Vasopressin, epinephrine H2 receptors: ranitidine, fomatidine Coagulants: tranexamic acid, vitamin K Antiepileptic: carbamazepine, valporate Fluid restriction Blood Transfusion NG tube insertion for lavage

16. Surgical management Exploratory Laparotomy : In cases of severe or uncontrolled bleeding, an exploratory laparotomy may be performed. This involves making an incision in the abdominal wall to visually inspect the GI tract and identify the source of bleeding.

17. Surgical management Gastric Surgery : For bleeding ulcers that do not respond to medical or endoscopic treatment, partial gastrectomy (surgical removal of part of the stomach) may be considered.

18. Surgical management Duodenal Surgery: In cases of bleeding from the duodenum, surgical procedures such as duodenostomy or duodenectomy may be performed.

19. Surgical management Small Bowel Resection : When bleeding originates from the small intestine, a segmental resection of the affected part of the small bowel may be necessary.

20. Surgical management Colon Resection : Colonic bleeding may require partial or total colectomy, depending on the location and extent of the bleeding. This is often considered when other interventions are not successful.

21. Surgical management Splenectomy : In cases where bleeding is associated with portal hypertension or splenic artery aneurysms, removal of the spleen (splenectomy) may be necessary.

22. Surgical management Surgery for Variceal Bleeding : In cases of severe variceal bleeding, emergency surgical procedures such as portocaval shunts or devascularization may be considered.

23. Complications respiratory distress heart attack infection shock death