GI Disorders Lecture in GERIATRI System, FKUH

Acute gastrointestinal bleeding is a

condition that required earlier and intensive
care which are suddenly life threatening.
Chronic gastrointestinal bleeding occurs in
slow and intermittent time until the
symptoms from blood loss or anemia will
result

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INTRODUCTION
Acute bleeding
- hematemesis / melena
- melena
- hemochezia (lower GI)
- intraperitoneal hemorrhage

Chronic bleeding
- Bleeding occult or hidden iron-deficiency
anemia
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Variceal bleeding dan non variceal bleeding

UPPER GI TRACT.
Variceal
Gastroesophageal varices
Non variceal
Peptik ulcer
Stress ulcer
Mallory-Weiss tear
Duodenitis / esophagitis
Tumor / Carcinoma
Telengectasia herediter
Hemostatic defect
Angiodysplasia
Dieulafoys lesion
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LOWER GI TRACT.
Hemorrhoid
Colorectal carsinoma
Ulcerative colitis
Colorectal polyp
Diverticular disease
Iskemia colitis
Crohns disease
Angiodysplasia
Intestinal hemorrhage


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Syncope : tachycardia, headache, drowsy
Shock : hypotension (systolic blood pressure,
<100 mm Hg), rapid pulse (100
beats per minute), palor (skin and
mucosa), cold extremity
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UGI LGI

Manifestation Hematemesis Hematokezia
Melena
Nasogastric aspirate Blood Clear
BUN/creatinin ratio Increase Normal
Peristaltic Hyperactive Normal

Identifies the source of the bleeding after
restoring stability patient hemodynamic

Anamnesis :
peptic ulcer, NSAID, chronic liver
disease, LGI disorders (hemorrhoid)

Physical examination
Search for the cause of bleeding
according anamnesis or others etiology
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Nasogastric tube for diagnosis (do not insert
permanently due to worsen the disorders)
Rectal examination
UGI / LGI Endoscopy

Laboratory Examination:
routine blood/ urine
BUN / S creatinin
LFT
PT/aPTT

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The Aim : - hemodynamic stability
- stop active bleeding
- prevent rebleeding

Patients Resuscitation :
intravenous fluids, correct the airways
measurement the grading of blood loss (pulse
and systolic blood pressure)
Pulse 100 beats/minute colloid/NaCl 0.9%
infusion


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POSTURAL SIGNS

Principle :
Blood loss loss of intravascular volume
- a drop in Cardiac output & blood pressure.
- rapid pulse

To estimate the intravascular volume status :
Patient lay down measurement of pulse and blood
pressure then patient sit down with measurement
repeated
If an increase in the pulse of 10 beats per minute or
a drop in systolic blood pressure of 10 mm Hg
about 20% of blood loss prediction

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In Shock patient, systolic blood pressure 90
mmHg & pulse > 100 beats/mnt, cold sweat,
pallor, cold extremity about 40% of blood
loss prediction

Obtain blood type and cross-match for
transfusion, level of hematocrite (hemoglobin
level not fit to quantity of acute bleeding
because of require 8 hours minimal for
hemodilusion to occur

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Shock patient
Bleeding continously
Symptoms of angina pectoris
Hematocrite < 20%
High risk patients : older patients, coexisting
cardiac illnesses, hepatic cirrhosis transfusion
of packed red cells until Ht > 30%
Young healthy patients transfusion of whole
blood until Ht > 20%
Use transfusion of fresh frozen plasma for
coagulopathy and transfusion of trombocyte for
low of trombocyte

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Initiation for immediate transfusion :
Hemodynamic state is a good indicator for
blood transfusion better than Hb.
Transfusion to be given until restoring
hemodynamic stability or Ht 25 30%

Causal Therapy
Dependent of Etiology
Endoscopic treatment
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Fig. 2 Investigation algorithm for acute GI bleed.
Confirm acute upper/lower GI bleed
Assess severity
Resuscitate
Low risk Severe/high risk
Ongoing bleeding
Endoscopy on
next available list
Urgent endoscopy
Endoscopic
therapy +
Monitor
closely
Surgery Monitor
closely
High-risk
lesion
Low-risk
lesion
Endoscopic
therapy
Early
discharge
Period of observation
before discharge