UGI Bleed

UGI Bleed
125 slides Presentation by:
Obie M. Powell, M.D.
Joseph A. Iocono, M.D.
Department of Surgery
University of Kentucky

Case study:
History
Characterization of Symptoms
Temporal Sequence
Alleviating / Exacerbating Factors
PMH
Family/Social History
What is your Differential Diagnosis?

Differential Diagnosis

* Esophageal varices
* Gastric varices
* Erosive gastritis
* Mallory Weiss tear
* Reflux esophagitis
* Gastric malignancy
* Vascular malformations
* Nose bleed
* Aorto-enteric fistula
* Gastric ulcer
* Duodenal ulcer

Physical Exam
Laboratory studies:
What is necessary?

* Type and Cross
* CBC: Do you expect anemia?
* CMP: evaluate for hepatic dysfunction and renal compromise
* Coags: active hemorrhage can cause coagulopathy and requires aggressive replacement
* ABG: probe for acidosis

Laboratory Values Discussion
Endoscopy
Surgery for Bleeding Ulcers
Operative Indications
Operative Technique
Gastrointestinal Bleeding
Discussion
Upper Gastrointestinal Bleeding
Lower Gastrointestinal Bleeding
Rectal and Anal Bleeding


Upper GastroIntestinal Bleed.ppt

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Gastro Intestinal Bleeding

Gastro Intestinal Bleeding
Presentation by:David A. Gremse, MD, FAAP, FACG
Professor and Chair of Pediatrics
University of Nevada School of Medicine

Gastrointestinal Bleeding

* Hematemesis- Vomiting of bright red blood
o usually represents bleeding proximal to the ligament of Treitz
* Hematochezia- bright red blood per rectum
o indicates a lower GI source of bleeding
* Blood has a laxative effect so with massive bleeding the stool may be bright red
* Blood streaks on the stool indicates anal outlet bleeding
* Blood mixed with stool indicates bleeding source higher than the rectum
* Blood with mucus indicates an infectious or inflammatory disease
* Currant jelly-like material indicates vascular congestion and hyperemia (intussusception or midgut volvulus)
* Maroon-colored stools indicate voluminous bleeding proximal to the rectosigmoid area
* Melena, passage of black, sticky (tarry) stools suggests upper GI tract bleeding, but can be as distal as the right colon
* Hematemesis suggests a large bleed with possible recurrence, melena alone indicates less voluminous bleeding

Causes of Upper GI Bleeding

* Common
* Nasopharyngeal bleeding
* Erosive Esophagitis
* Peptic ulcer
* Gastritis (H. pylori)
* Mallory-Weiss tear
* Prolapse gastropathy

* Less Common
* Bleeding disorders
* Duplication cyst
* Foreign body
* Tube trauma
* Vascular malformation
* Esophageal varices


Causes of Lower GI Bleeding

* Common
* Anal fissure
* Infectious colitis Salmonella, Shigella, Campylobacter, C.diff
* Inflammatory bowel disease
* Intussusception
* Upper GI source

* Less Common
* Meckel’s diverticulum
* Duplication cyst
* Hirschsprung’s enterocolitis
* Gangrenous intestine
* Vascular malformation

Clinical Findings in PUD Neonatal Period
Clinical Findings in PUD Infants and Toddlers
Clinical Findings in PUD Pre-Schoolers
Clinical Findings in PUD School Age
Pathophysiology of GI Bleeding
Causes and Effects of H+ Ion Backdiffusion
Lowflow states Drugs, EtOH Stress H. pylori Bile Reflux
Mucosal Barrier Break
Parietal Cells
Release of histamine + Vasodilatation
Increased HCl and Pepsin Secretion
Peptic Ulcer Disease Diagnostic Evaluation
Indications for EGD
Case #1 – UGI Bleeding
Esophageal varices
Case #2 – UGI Bleeding
Prolapse Gastropathy
Meckel’s Scan
99mTc- Labeled Red Cell Scan
GI Bleeding - Treatment
Drug Efficacy in Healing Ulcers
ATLS Classification of Shock
Management - Octreotide
GI Bleeding – Summary
Questions

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Upper Respiratory Tract Infections

Upper Respiratory Tract Infections
Presentation by:Divya Ahuja, M.D.

Burden of Upper Respiratory Tract Infections
The Common Cold
Transmission of rhinoviruses
Clinical characteristics
Diagnosis and treatment
Acute bacterial sinusitis
Paranasal sinuses
Acute sinusitis: complications
Case study
Chronic sinusitis
Spectrum of fungal sinusitis
Otitis externa
Malignant otitis externa
Acute otitis media
Acute otitis media
Diagnosis and treatment
Chronic otitis media and mastoiditis
Acute pharyngitis
Acute pharyngitis: physical exam
Pharyngoconjuntival fever
Vesicular lesions
Vincent’s angina and Quinsy
Diphtheria
Miscellaneous causes of pharyngitis
Treatment
Acute laryngotracheobronchitis
Acute epiglottitis
Acute suppurative parotitis
Deep fascial space infections of the head and neck
Severe acute respiratory distress syndrome (SARS)

SARS: CDC case definition

* Respiratory illness of unknown etiology AND
* Measured temperature > 100.4 degrees F (38 degrees C) AND
* One or more clinical findings of respiratory illness AND
* Travel within 10 days of onset of symptoms to an area with documented or suspected cases OR close contact with a case
* Clinical findings of respiratory illness: cough, SOB, dyspnea, hypoxia, or radiographic findings of either pneumonia or ARDS
* Travel includes certain areas (mainland China, Hong Kong, Hanoi, Singapore) and also airports with documented or suspected community transmission

SARS: Radiographic findings

* Early: a peripheral/pleural-based opacity (ground-glass or consolidative) may be the only abnormality. Look especially at retrocardiac area.
* Advanced: widespread opacification (ground-glass or consolidative) tending to affect the lower zones and often bilateral.
* Pleural effusions, lymphadenopathy, and cavitation are not seen.

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