UGI bleeding.pptx

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UGI Bleeding


Upper GI Bleeding
Etiology and Pathophysiology
Common Causes : Esophageal origin
Common Causes : Stomach and duodenal origin
Peptic Ulcers
Common Causes: Drug-induced origin
Common Causes: Systemic disease origin
Emergency Assessment & Management
Diagnostic Studies
Diagnostic Studies: Angiography
Collaborative Care: Endoscopic therapy
MBL(multiple band ligation)
HemoClipping
Collaborative Care: Endoscopic therapy
Collaborative Care: Surgical therapy
Collaborative Care: Drug therapy
Nursing Management
Case sudy

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UGI Bleeding




Upper GI Bleeding
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□ 150,000 to 200,000 hospital admissions each year for UGI bleeding
□ Mortality rate 6% to 10% for past 40 years
□ Increased incidence of UGI bleeding in older adults, especially women, and use of NSAIDs




Etiology and Pathophysiology
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□ Most serious loss of blood from UGI characterized by sudden onset
□ Insidious occult bleeding can also be a major problem
□ Severity depends of bleeding origin
　☐ Venous
　☐ Capillary
　☐ Arterial




Etiology and Pathophysiology
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□ Types of UGI bleeding
　☐ Obvious bleeding
　　■ Hematemesis
　　　▩ Bloody vomitus
　　　　▇ Appears fresh, bright red blood or “coffee grounds”
　　■ Melena
　　　▩ Black, tarry stools
　　　　▇ Caused by digestion of blood in GI tract
　　　　▇ Black appearance—iron
　　■ Hematochezia
　　　▩ Bight ed or maroon rectal dischage.
　　　　▇ 11% ae UGI Bleeding.




Etiology and Pathophysiology
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　　■ NG Lavage
　　　▩ Positive result
　　　　-Blood or coffee ground material
　　　▩ Negative Result
　　　　-Bile with no blood
　　　　-Bleeding stopped
　　　　-Bleeding beyond closed pylorus
　☐ Occult bleeding
　　■ Small amounts of blood in gastric secretions, vomitus, or stools
　　■ Undetectable by appearance
　　■ Detectable by guaiac test




Etiology and Pathophysiology
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□ Bleeding from arterial source is profuse, and the blood is bright red
□ The bright red color indicates that the blood has not been in contact with the stomach’s acid secretions
□ “Coffee ground” vomitus reveals that the blood has been in the stomach for some time and has been changed by gastric secretions
□ Melena: Slow bleeding from an upper GI source




　≪ … 중 략 … ≫




Collaborative Care: Drug therapy
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□ Drug therapy
　☐ During acute phase used to
　　■ ↓ Bleeding
　　■ ↓ HCl acid secretion
　　■ Neutralize HCl acid that is present
　☐ Injection therapy during endoscopy for acute hemostasis
　☐ Bleeding due to ulceration
　　■ Epinephrine
　　　▩ Produces tissue edema → pressure on bleeding source
　　■ Usually combined with other therapies




Collaborative Care: Drug therapy
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　☐ IV or intraarterial vasopressin
　　■ For variceal bleeding
　　■ Causes vasoconstriction, ↑ smooth muscle activity of GI tract
　　■ Used in patients who do not respond to other therapies and poor surgical risk
　　■ Side effects: ↓ myocardial contractility, ↓ coronary blood flow, visceral and peripheral ischemic side effects
　　■ Used cautiously in those with vascular disease




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Case sudy
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□ (1) 초기사정자료
□ 이름: 김..
□ 나이/성별:
□ 입원일 : 2011.3.10
□ 진단명: alcoholic liver cirrosis
□ 주증상: Rt back pain, G-weakeness, dizziness, Nausea, Vomiting gingival bleeding 3-4일 전부터 상기증상 있어 내원
□ 과거력 -HTN, LC
□ 수술경력: cholecystectomy-2010.2(본원)
　　　　　hystrectomy-5~6년전(수원빈센트)
□ 가족력- 어머니-DM 언니-Stomach Cancer
□ 활력증후: v/s BP-110/60mmHg .BT 36.7℃ , P-72회 , R-20회

키워드

상부위장관출혈,   UGI bleeding,   위장관출혈,   케이스 스터디,   출혈,   병태생리,   궤양,   치료