gastrointestinal bleeding

Question 1

causes

Answer 1

• Duodenal, gasric ulcer
• Hemorrhagic gastropathy & erosions
• Mallory-Weiss syndrome
• Gastric varices
• reflux oesophagitis
• ischemic colitis
• polyps
• diverticula
• Crohn‘s ulcerative infective colitis
• Haemorrhoids
• Anal fissure
• Solitary ulcer in rectum
• Meckel‘s diverticulum
• Carcinoma of ceacum
• Angiodysplasia

Question 2

clinical picture

Answer 2

• constipation, melena, vomiting with coffee ground mass
• After bleeding, pain disspear bcoz of its alkaline rXn neutralizes stomach‘s acid.
• weakness, vertigo, pale skin, tachycardia, dyspnea, low arterial pressure

Question 3

emergency care

Answer 3

• monitor bp & pulse, ice per os & on epigastric, cold food (ice-cream), drugs (vicasol-vitamin K), statin-after 3 days, thrombocyte aggregant (Dixinom)
• Instrumental: embolization, tamponade, infusion of fluid (glucose, ringer, NaCl 0.9%, albumin, plasma, RBC. If still x stop: surgery (Billroth 1 or 2/ gastroectomy)

Question 4

investigatoin

Answer 4

• systolic murmur at apex
• blood analysis (Hb & Ht, coagulation)
• endoscopy- to detect cause & localization of Hemorrhage.
• rectal examination ( eg. carcinoma )
• proctoscopy ( eg. haemorrhoids )
• sigmoidoscopy ( eg. inflammatory bowel disease )
• barium enema – ischemic colitis
• colonoscopy – for any mucosal lesion and removal of polyps
• angiography – vascular abN ( eg. angiodysplasia)

Question 5

tactic

Answer 5

• Place cold compression on GI region or per os (ice)
• Transfusion of crystalloids, colloids RBC mass
• Stop bleeding – vicasol (vit K), Dixinom (aggregation of thrombocyte), epsilone amino caproic acid.
• Fibrogastroduodenoscopy
• Surgical - coagulated vessel, temponate PU, resection part of stomach, Bilorth I or II, Gastrectomy, gastrostomy