Definition and causes
Upper gastrointestinal bleeding ( HDS ) is an emergency surgical blood loss represented by the upper segments of the digestive tract (esophagus stomach , duodenum ), which may protrude or by haematemesis or melaena .
Haematemesis = vomiting blood ;
Melaena = loss of blood through defecation . The seat has the appearance of oil.
HDS causes digestive problems or extradigestive be .
Digestive disorders :
⁃ ruptured esophageal varices ;
⁃ benign and malignant tumors ;
⁃ esophageal ulcer ;
⁃ erosive esophagitis ;
⁃ or iatrogenic trauma by foreign body ( endoscopic exploration , biopsy , dilatation ) ;
⁃ Mallory -Weiss syndrome ;
⁃ diverticula .
– Gastric :
– Gastric ulcer ;
– Meligne and benign tumors ;
– Diverticula ;
– Hemorrhagic gastritis , toxic, caustic medicines;
– And iatrogenic hiatal hernias ;
– angiodisplazii , foreign body , gastric banding ;
– duodenum :
⁃ – duodenal ulcer ;
⁃ – diverticula , tumors ;
⁃ – ampulom vaterian , telangiectasia , polyposis ;
⁃ – iatrogenic .
– Biliary :
⁃ – liver trauma , tumors hepetice and CBP ;
⁃ – liver resection , drilling CBP .
– Acute pancreatitis.
Extradigestive disorders :
– Stress ulcer ( trauma , burns, shock) ;
– HTP (cirrhosis ) ;
– Diseases of the blood ( hypocoagulability ) ;
⁃ systemic diseases : amyloidosis , myeloma , sarcoidosis , kidney failure, severe infection , heart failure, parasites , etc.
Clinical and laboratory diagnosis
On clinical examination it is found :
– Haematemesis, melena or hematochezia ( fresh blood and rectal chiaguri ) ;
– Thirst , shortness of breath , dizziness , asthenia, lipotimii ;
– Personal medical history : hepatitis , ulcers, blood disorders , medications (aspirin , Coumadin ) ;
– Cold extremities , sweating , paleness , decreased BP , increases AV .
Laboratory investigations will include:
a) laboratory exam that will determine:
– Hemoglobin, hematocrit , coagulation tests , urea ;
– Investigation of liver function : transaminases , bilirubin, cholinesterase .
– Renal investigations : urea , creatinine , ionograme .
Severity criteria are given by: AV > 100 , BP < 100; Hb <8 ; Ht <30 % PVC <2 ; diuresis < 40ml .
b ) imaging exams :
– Endoscopy , most reliable method (over 95% correct diagnoses ) ;
– Radiography with contrast ;
– Selective angiography ;
– Scintigraphy .
Treatment of upper gastrointestinal bleeding should be performed nuanced , depending on the severity of the case. Basically two types of binding measures include : resuscitative as supportive and stop bleeding. In addition to these times , and treatment of the underlying disease pathology .
Therapeutic modalities are: medical and surgical .
Medical treatment consists of:
1 ) Rebalancing in severe bleeding :
– Positioning the patient supine with legs slightly raised ( Trendelenburg ) ;
– Monitoring of vital constants (TA , AV, respiratory rate ) ;
– 1-2 vein catheterization , which is harvested : blood group , hemoglobin , hematocrit , platelets, erythrocytes, coagulation tests , urea ;
– Oxygen ;
– Nasogastric probe ;
– Monitoring of urine output ;
– Fluid resuscitation ;
– Digestive absolute rest .
2 ) Correction of coagulation , is made with : fresh plasma , vitamin K , calcium gluconate , platelets ( in thrombocytopenia ) ;
3 ) Antioxidants , especially in HDS ulcer and hemorrhagic gastritis ;
4 ) Prostaglandins E and A are potent inhibitors of gastric secretion , 5 ) Vasopressin is a potent vasoconstrictor that stops HDS in 75 % of cases ;
6 ) somatostatin splanchnic nerve causes vasoconstriction and decreased portal pressure ;
7 ) Hypothermia stomach ( gastric lavage with cold saline ) ;
8 ) propranolol has a role in the prevention of bleeding varices broken or erosive gastritis ;
9) endoscopic ;
10 ) hemostasis through angiographic embolization , injection of vasopressin ;
11) wells double balloon compression in esophageal varices broken
Approximately 90 % of cases of HDS stop medical therapy . 10% of the cases , however, require emergency surgery.
Surgery is indicated in the following cases : cataclysmic hemorrhage , severe bleeding especially associated with hypotension, bleeding that does not stop despite medical therapy , recurrent bleeding after initially stopped, special situations (patients who refuse transfusion , or a rare blood type ) .
The surgical procedure is applied differently depending on the cause of the bleeding.