Transcript Bleeding from the Gut Clinical approach

Bleeding from the Gut
Clinical approach
• Severity
Vital signs
Haematocrit
Beware ongoing losses
• Acute onset or chronic blood loss
Fe deficiency
• Stigmata of disease
Failure to thrive and grow
Purpura
Liver and spleen
Site of bleeding
• Haematemesis
Fresh blood
swallowed, rapid haemorrhage
Altered - “coffee ground”
gastric acid
Site of bleeding
• Bleeding per rectum
Fresh blood not mixed with stool
low rectum and anus
Fresh blood with mucus - dysentery
colon and rectum
Jellied dark blood
intussusception
Melaena - tarry black
bleeding from higher up
Bleeding from the gut
• Bleeding tendency
Vitamin K deficiency
Hepatic failure
Disseminated intravascular coagulation
septicaemia, necrotising enterocolitis
Thrombocytopaenia
haemolytic uraemic syndrome
Vasculitis - Henoch Schonlein purpura
Bleeding from the Gut
• Swallowed blood
Maternal blood swallowed intrapartum
Apt test
Nose bleed
Mouth and pharynx
• Oesophagus
Varices (portal hypertension)
Oesophagitis (peptic or other)
Mallory-Weiss tear
Bleeding from the Gut
• Stomach
Gastritis and erosions
Ulcer (peptic, stress)
• Small gut
Meckel diverticulum
Ulcers (peptic and inflammatory)
Intussusception
Volvulus
Polyps
Bleeding from the Gut
• Large gut
Dysentery (amoebic, bacterial)
Intussusception
Polyps
Ulcerative colitis
• Rectum and anus
Varices
Polyps
Trauma
Anal fissure
Bleeding from the gut
Management
• Resuscitation as required
• Stop the bleeding
mostly spontaneous
vitamin K
blood component therapy
emergency endoscopic approach
Bleeding from the Gut
Management
• Identify the site of haemorrhage
History
Character of blood
Upper gut: endoscopy
Lower gut:contrast studies
isotope scan “Meckel scan”
endoscopy
• Identify and manage aetiology
• Follow-up for recurrence
Dysentery
• Mucosal invasion or toxin mediated
inflammation with necrosis
bacteria - shigella, Esch.coli, others
Entamoeba histolytica, trichiuris
• Fever, abdominal pain, extraintestinal
features
• Sometimes onset in “gastro-like” fashion
• Major complications