1. UPPER GI BLEED

2. AETIOLOGY

4. PEPTIC ULCER
• Breaks in the mucosal surface >5 mm
• 2 types-
• Duodenal Ulcers
• Gastric Ulcers
• NSAIDS H.Pylori
PEPTIC ULCER

5. GASTRIC EROSIONS
• GASTRITIS
• Alcohol intake
• NSAID use
• Stress

6. ESOPHAGITIS
• Inflammation of esophageal
mucosa
a) GERD
b) Barret Esophagus
c) Chemical Esophagitis-
alcohol,acids,alkalis
d) Infectious esophagitis-
HSV,CMV,fungal

7. Mallory-Weiss tear
• Longitudinal tears
• Alcoholics
• Symptoms :
• Vomiting
• retching HEAMATEMESIS
• Coughing

9. ESOPHAGEAL VARICES
• Liver diseases–
Cirrhosis
• Portal Hypertension

10. NEOPLASMS
• Ca.esophagus-
Squamous cell Ca
Adeno Ca
• Ca.stomach-Second most common
Tumor

11. LESS COMMON CAUSES
• Vascular Malformations
Hereditary hemorrhagic telangiectasias
• Aorto-duodenal Fistula
• Hemosuccus pancreaticus
Bleeding from the bile duct or pancreatic
duct

14. CLINICAL
PRESENTATION

15. Bleeding - present in 5 ways.
1. Hematemesis - red blood or
"coffee-ground" material.
2. Melena - black, tarry, foul-smelling
stool.
3. Hematochezia - passage of bright
red or maroon blood from the
rectum.

16. 4. Occult GI bleeding –
absence of overt bleeding
fecal occult blood test - +ve
presence of iron deficiency.
5. symptoms of blood loss or anemia
light
headedness, syncope, angina, or
dyspnea.

17. I. HAEMATEMESIS
• vomiting of blood follows bleeding
from esophagus ,stomach and
duodenum( above the duodenal
flexure)
COMMON CAUSES
i. Ruptured oesophageal varices
ii. Esophageal carcinoma
iii. Chronic gastric ulcer

18. iv. Carcinoma stomach
v. chronic duodenal ulcer
vi. Mallory Weiss syndrome
LESS COMMON CAUSES
• blood dyscrasias
• Lymphoma of stomach
• Anticoagulant therapy
• Uraemia

19. • If the source of bleeding is above
gastro-oesophageal sphincter ( eg :
oesophageal varices) fresh blood
wells up in mouth than being
actively vomited

20. Mallory – Weiss tear-
patient vomits several times
fresh blood only appears
after the initial vomit

21. • Sudden loss of > 20%
-tachycardia
, hypotension, faintness and
sweating
• Brisk hematemesis -from large
vessel in an ulcer BRIGHT RED
• Bright red blood –naso or oro
pharynx

22. • Slower upper GI bleeding-
mixing of blood with gastric
juice
darker, like that of ground coffee

23. II. MELAENA
 - black , tarry stools containing
occult blood
 -Upper GI bleeding
 -Haemorrhage from right side of
colon
 -appx 60 ml of blood - single
black coloured stool

24. Blood for 14 hrs in the GI tract
• Characteristics
i. Black tarry stool- due to production
of acid haematin
ii. Offensive odour - acid haematin is
altered by bacteria
iii. Semisolid in consistency
iv. Usually associated with vertigo
, dizziness, syncopal attack during
defecation

25. • Causes – all the causes of
haematemesis may produce
melaena
• Rarely, swallowed blood give
rise to melaena: epistaxis

27. Thank you...