خونریزیهای حاد دستگاه گوارش

خونریزیهای حاد دستگاه گوارش

اسلاید 1: Acute Gastrointestinal Hemorrhage خونریزیهای حاد دستگاه گوارشدکتر محمد برهمتمتخصص جراح عمومیبیمارستان هفده شهریورRef: 1) Sabiston 2016 2) Schwartzs Principles of Surgery 2014 3) Dr. Mohammad Mobasheri(https://www.sgsu.org.uk/pageassets/societies/society/ois/resources/GI-bleed.ppt)

اسلاید 2: GI BleedingMaybe classified into:Upper GI bleeding (proximal to DJ flexure)Variceal bleedingNon-variceal bleeding (Peptic ulcer , … )Lower GI bleeding (distal to DJ flexure)Colon (diverticula , angiodysplasias, …)small intestineObscure bleedingOccult bleedingUpper GI bleeding 4x more common than lower GI bleeding

اسلاید 3: In past 20 yearsIncreased use of NSAIDs* & SSRIs**⇈GI bleeding use of PPIs*** & anti H.pylori ⇊GI bleeding ►►►► The overall result ►► ⇓ 4%*nonsteroidal anti-inflammatory drugs**selective serotonin reuptake inhibitors***proton pump inhibitorsGI Bleeding

اسلاید 4: Management of these patients is frequently multidisciplinaryemergency medicinegastroenterologyintensive careSurgeryinterventional radiologyEmergency resuscitation is same for upper and lower GI bleeds GI Bleeding

اسلاید 5: Emegency Resuscitation

اسلاید 6: Takes priority over determining the diagnosis/causeABC (main focus is ‘C’)Oxygen: 15L/m Non-rebreath maskIV Line (2 large bore cannulae into both ante-cubital fossae )Take bloods at same time for CBC, Urea & Electrolytes, LFT, PT, PTT, Clotting, cross match 6 UnitsUrine CatheterIV Fluid initially (a 2-liter bolus of crystalloid solution, usually lactated Ringer )then blood as soon as available (depending on urgency : O- ⇔ Group specific ⇔ fully cross-matched)depends to (response to the IV fluid, age, concomitant cardiopulmonary disease, bleeding continues)Monitor response to resuscitation frequently (HR, BP, urine output, level of consciousness, peripheral temperature)Stop anti-coagulants and correct any clotting derrangementNG tube and aspiration (will help differentiate upper from lower GI bleed)Organise definitive treatment (endoscopic/radiological/surgical)Emegency Resuscitatio