Upper G.I bleed is a medical emergency. The causes can be bleeding from pharynx, oesophagus , stomach and duodenum. Causes are A bleeding peptic ulcer . Bleeding ruptured esophageal varices Acute bleeding gastric erosions A Mallory Weis tear Angiodysplasia . Bleeding disorders Ca stomach Steps in management 1.Initial resuscitation- check vital parameters and if in shock- fluid resuscitation and if possible blood transfusion 2.Endotracheal intubation in critically drowsy patient can save life and even facilitate urgent upper G.I endoscopy 3.Take a detailed history which can give clue to the cause of bleeding like history of APD , cirrhosis of liver , esophagitis 4.URGENT EMERGENCY UPPER G.I ENDOSCOPY is the most important step to save life . If there is bleeding esophageal varices - esophageal banding will immediately stop bleeding Also bleeding peptic ulcer , acute erosions , CA stomach , angidysplasia can be diagnosed- which will help us to plan treatment for respective diseases. If endoscopy is normal - we may think of bleeding disorders
Upper GI bleeding Causes Causes can include: Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading to formation of sores. Tears in the esophagus. Known as Mallory-Weiss tears, they can cause a lot of bleeding. These are most common in people who drink alcohol to excess. Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with serious liver disease. Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease (GERD). R/O the cause and based on which plan the treatment.
First few steps in management of upper GI bleed 1) Check pulse and cardiac activity Check airway and breathing - if compromised intubate and follow advanced cardiac life support guidelines 2) Secure intravenous line for giving fluids. Collect blood from IV line and send it for blood grouping and cross matching, complete blood count, coagulation profile, liver and renal function test, Electrolyte 3) Insert Rules tube - give rules tube wash to remove blood from stomach and reduce chances of vomiting and aspiration 4) Brief assessment to find our Cause of bleeding and start treatment of same
In ugib correct shock coagulation factor give pack cell transfusion mostly oesopaheal or peptic cause do endoscopy then treat accordingly peptic ulcer oesopaheal varices sclerotherapy usg abdomen
TO CORRECT .. SHOCK AND COAGULATION ABNORMALITIES..AND.. TO STABILIZE PATIENT.. SO..THAT ..THE FURTHER EVALUATION..AND..MANAGEMENT.. CAN BE PROCEED..
Upper gastrointestinal bleed (UGIB) correct shock(if following ACLS Protocol) and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed. Intravenous (IV) fluids, patients may need transfusion of packed red blood cells.Early endoscopy to find out peptic ulcers and gastritis,mallory Weiss tears, varices etc.
Stabilize patient first of all by ABC,hemodynamically unstable if then infuse blood ,cold wash with ns ,once stabilize go with endoscopy within 24hrs
Agree with Dr. Parveen Yograj Sir... well explaine
I agree with Dr.Jayesh Kalbhande
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Hemetemesis In 10 years old girl child. what should be the probable cause? Gushing of Blood like FloodDr. Saurabh Suman Prasad17 Likes33 Answers
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Friends today I am discussing about Heartburn. What is heartburn? Despite its name, heartburn doesn’t affect the heart. Heartburn is a burning feeling in the lower chest, along with a sour or bitter taste in the throat and mouth. It usually occurs after eating a big meal or while lying down. The feeling can last for a few minutes or a few hours. Symptoms of heartburn Heartburn symptoms vary. They may be slight or extreme. The severity of heartburn may depend on what you have eaten and how much you have eaten. The main symptom of heartburn is a burning feeling in your throat and chest. This happens when when the acidic liquid from your food or drink comes back up into your esophagus. You may have difficulty swallowing or choke on this acid. It may even make you hoarse or cough. What causes heartburn? When you eat, food passes from your mouth down a tube called the esophagus. The esophagus is about 10 inches long in most people. To enter the stomach, the food must pass through an opening between the esophagus and stomach. This opening acts like a gate to allow food to pass into the stomach. Usually, this opening closes as soon as food passes through. But if it doesn’t close all the way, acid from your stomach can get through the opening and into your esophagus. This is called reflux. Stomach acid can irritate the esophagus and cause heartburn. Hiatal hernia can also cause heartburn. Hiatal hernia is a condition in which part of the stomach is pushed up through the diaphragm (the muscle wall between the stomach and chest) and into the chest. Sometimes this causes heartburn. How is heartburn diagnosed? You probably do not need a doctor to diagnose heartburn. Heartburn symptoms are easy to recognize. And there are many over-the-counter medicines to help manage symptoms. If you are questioning whether you have heartburn, you should ask your doctor. He or she will likely be able to diagnose you based on your symptoms. Can heartburn be prevented or avoided? You might be able to avoid heartburn by making some changes in your lifestyle. Tips for preventing heartburn include: Place 6- to 9-inch blocks under the legs at the head of your bed to raise it. Try to eat at least 2 to 3 hours before lying down. If you take naps, try sleeping in a chair. If you smoke, quit. Lose weight if you’re overweight. Don’t overeat. Eat high-protein, low-fat meals. Avoid tight clothes and tight belts. Avoid foods and other things that give you heartburn. Things that can make heartburn worse Many things can make heartburn worse. Heartburn is most common after overeating, when bending over or when lying down. Pregnancy, stress, and certain foods can also make heartburn worse. Things that can make heartburn worse: Cigarette smoking. Coffee (both regular and decaffeinated) and other drinks that contain caffeine. Alcohol. Carbonated drinks. Citrus fruits. Tomato products. Chocolate, mints, or peppermints. Fatty foods or spicy foods (such as pizza, chili, and curry). Onions. Lying down too soon after eating. Being overweight or obese. Aspirin or ibuprofen (one brand name: Motrin). Certain medicines (such as sedatives and some medicines for high blood pressure). Heartburn treatment If lifestyle changes and antacids don’t help your symptoms, talk with your doctor. Your doctor may want you to take prescription medicine. Or he or she may schedule you for some tests. Tests might include: pH test to check for acid in the esophagus. Endoscopy to check for other conditions. During an endoscopy, your doctor looks into your stomach through a long, thin tube. This tube is inserted down your esophagus. Your doctor may also check for pylori, bacteria that can cause ulcers. What about medicines for heartburn? Several kinds of medicine can be used to treat heartburn. Antacids neutralize the acid that your stomach makes. For most people, antacids that you can get without a prescription (over-the-counter) give fast, short-term relief. However, if you use antacids too much, they can cause diarrhea or constipation. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide. One causes constipation while the other causes diarrhea. So they counteract each other. Some brands of antacids include Maalox, Mylanta, and Riopan. Follow the directions on the package. H2 blockers (some brand names: Pepcid, Tagamet, Zantac) reduce the amount of acid your stomach makes. Several are available without a prescription. Other medicines, such as omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid), also reduce how much acid the stomach makes. Metoclopramide (brand name: Reglan) reduces acid reflux. To find out what medicine is right for you, talk with your doctor. Can heartburn be serious? If you have heartburn only now and then, it’s probably not serious. However, if you have heartburn frequently, it can lead to esophagitis (an inflamed lining of the esophagus). If esophagitis becomes severe, your esophagus might narrow. This can cause bleeding or trouble swallowing. If you get more than occasional heartburn, it may be a symptom of something more serious. It could mean that you have: acid reflux disease gastroesophageal reflux disease (GERD) an inflamed stomach lining (gastritis) hiatal hernia peptic ulcer. Living with heartburn Sometimes pain in the chest may be mistaken for heartburn when it’s really a sign of heart disease. If you have any of the symptoms below, call your doctor. You have trouble swallowing or pain when swallowing. You’re vomiting blood. Your stools are bloody or black. You’re short of breath. You’re dizzy or lightheaded. You have pain going into your neck and shoulder. You break out in a sweat when you have pain in your chest. You have pain when you exercise. You have heartburn often (more than 3 times a week) for more than 2 weeks. Primary Homoeopathic Remedies Carbo vegetabilis This remedy relieves bloating and gas in the stomach, with belching. Lycopodium This remedy relieves discomfort and indigestion, with bloating around the waist and gas, especially after eating onions or garlic. Natrum carbonicum This remedy can be helpful to mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets. Indigestion, heartburn, and ulcers can occur if offending foods are eaten. Milk or dairy products can lead to flatulence or sputtery diarrhea that leaves an empty feeling in the stomach. Cravings for potatoes and sweets are common; also milk, but it makes these people sick, so they have usually learned to avoid it. Nux vomica This homeopathic remedy relieves nausea and cramps from indigestion, especially after excessive eating of spicy foods or drinking of alcohol. Pulsatilla This helps relieve gastric discomfort caused by eating too much fatty food, cakes and ice cream, with bloating, belching and slow digestion. Other Remedies Antimonium crudum This relieves indigestion from eating too much, especially rich or acidic foods or cured meat. Symptoms are relieved by applying heat to the abdomen. Arsenicum album This remedy may be indicated if a person feels anxious, restless yet exhausted, and is worse from the smell and sight of food. Burning pain is felt in the stomach and esophagus, which often is relieved by warmth and sitting up. Vomiting and diarrhea are possible. Upsets from spoiled food or from eating too much fruit often respond to this remedy. Bryonia When this remedy is indicated, the stomach feels heavy, with rising acid and a bitter or sour taste. Pain and nausea are worse from motion of any kind. The person may have a dry mouth and be thirsty for long drinks, which may increase discomfort. Bryonia is strongly suggested if a person is grumpy and wants to stay completely still and not be touched or talked to. Cinchona officinalis This remedy relieves bloating of the abdomen and foul-smelling gas, sometimes with painless, but exhausting, diarrhea. Colocynthis This relieves abdominal cramps improved by bending over, with strong pressure and heat. Magnesia phosphorica This remedy relieves abdominal cramps improved by heat and bending over. Natrum phosphoricum A sour taste in the mouth, an acid or burning sensation in the stomach, sour vomiting, regurgitated bits of food, and a yellow coating on the tongue are all indications for this remedy. The person may have problems after consuming dairy products or too much sugar. Another indication for Natrum phos is a craving for fried eggs. Phosphorus Burning pain in the stomach that feels better from eating ice cream or other cold, refreshing foods suggests a need for this remedy. The person is usually thirsty for cold drinks, but often feels nauseous or vomits once liquids warm up in the stomach. People needing Phosphorus may have a tendency toward easy bleeding and sometimes develop stomach ulcers.Dr. Rajesh Gupta4 Likes2 Answers
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A chronic Alcoholic male aged 54 yrs presented with complaints of Malaena (on/off), abdominal distension, decreased urine output since 15 days and Altered Sensorium since 1 day.... He was found to be in Shock at presentation and was put on intropic support... comment on his condition and treatment approach to this patient...Dr. Hardik Ahuja1 Like23 Answers
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POST VIRAL COUGH… Persistent cough lasting >3 weeks following the acute symptoms of an upper or lower respiratory tract viral infection. Such patients are considered to have a subacute cough because the condition lasts for less than 8 weeks. The chest radiograph findings are normal and the cough eventually resolves in most of the cases on its own but in few patients persists…. and lead to unnecessary investigations.. The exact pathogenesis of the post viral cough is not known, But it is thought to be due to… the extensive inflammation and disruption of upper and/or lower airway epithelial integrity. In lower airway, this is often associated with the accumulation of an excessive amount of mucus hypersecretion There is also transient airway and cough receptor hyperresponsiveness; All of the above pathology contribute to the subacute cough No treatment guidelines are available. Therapy with antibiotics has no role except complicated by bacterial sinusitis The use of inhaled ipratropium may be helpful. Cough suppressant like dexromethorphan should be used to suppress the upper airway component Inhaled corticosteroids with or without bronchodialator may be used for a short period to tackle the bronchial inflammation. Associated gastroesophageal reflux disease, which may be a complication of the vigorous coughing may need treatment. Post viral cough is very common in our clinical practice both in children and adults.. Keeping this diagnosis in D/D and patience is needed in most of the cases.. It saves cost of investigations and treatment… I hope it will be helpful…..Dr. K N Poddar23 Likes32 Answers
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50 year female with reflux esophagitis,always having nausea,pain andomen,heaviness in head,Dr. Ankur Kumar Tanwar0 Like16 Answers