405130159
Upper GIT bleeding
= Manifestation are variations, from massive hemmoragic life-threatening until smooth
one even we doesn’t recognizing.
Classification
- Hematemesis “bloody vomit”, showing upper GIT bleeding at Proximal Lig. Treitz
- Melena “dark-bloody stool”, showing blood bonding w/ HCl that came from
gaster.
Epidemiology at Indonesia
= Rupture varises gastroesofagus (60%), Gastritis Erosive (30%), Peptic Ulcer (10%).
High mortality: 60% varises rupture are died.
Diagnostic Tools: CBC and CXR. Diagnosis: Firm based on anamnesis, P-E & founding
DD/: Hemoptisis , Hematokezia
Treatment
1) Stability of hemodynamic (IV), O2 line, urine catheterization (volume), Vital sign
2) NGT gastric flushing to made easier endoscopy
3) Bed-rest
4) Supplementation H2 inhb / PPI medication, Sulfractate, Antacid, Vit. K (hepar)
PEPTIC ULCER
Peptic Ulcer
• Peptic ulcer is the break of gastric mucosa due to
the corrosive action of pepsin and hydrochloric acid
on the mucosa of the upper gastrointestinal tract.
• Signs are abdominal discomfort, pain (burning builds
up for 1-2 hours, gradually decreases), or nausea.
• Gastric ulcer pain is aggravated by meals, whereas
the pain of duodenal ulcers is relieved by meals.
• Patients with gastric ulcer usually avoids food and
loses weight.
http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/esophag
us_stomach/peptic_ulcer_disease.pdf
• H.pylori colonizes in human stomach
• NSAIDS acidic diminishing the
hydrophobicity of gastric mucus gastric acid
& pepsin may injure the epithelium
• NSAIDS decreases the synthesis of mucosal
prostaglandin
RADIOLOGI (barium X-ray)
Laboratory Test
• Indication:
- Refractory patients (not healed after 8 weeks of
therapy)
- Recurrent disease
• Serum gastrin and serum calcium (screening for
gastrinoma and multiple endocrine neoplasia/MEN)
• Gastric acid analysis determine whether the ulcer
is caused by gastric acid hypersecretion (basal acid
output >10 mEq/hr) or decreased mucosal protection
• Gold standard for diagnosis of H.pylori :
endoscopic biopsy
• Urea breath test (UBT) simple and non-
invasive H.pylori infection
• H. pylori-positive IgG and IgA ELISA test levels
are slightly higher
• Esophagogastroduodenoscopy (EGD) most
direct and accurate method in diagnosing peptic
ulcer
Medical Therapy
1. Reduce gastric acidity inhibits or neutralize
acid secretion antacids, histamin H2-
receptors (cimetidine, ranitidine, famotidine,
nizatidine), PPI (proton pump inhibitors)
• Gold standard in treating peptic ulcer : PPI
(omeprazole, lansoprazole, pantoprazole,
rabeprazole, esomeprazole)
• PPI prevents NSAID-associated
gastroduodenal ulcers
Medical Therapy
2. Coat ulcer craters to prevent acid and pepsin from
penetrating to the ulcer base sucralfate
• Sucralfate stimulates prostaglandin promotes
to improve mucosal integrity and enhance epithelial
regeneration
INFECTIOUS DIARRHEA
Infectious Diarrhea
• Diarrhea : an alteration in a normal bowel
movement characterized by an increase in the
water content, volume, or frequency of stools.
• Infectious diarrhea : diarrhea due to an
infectious etiology, often accompanied by
symptoms of nausea, vomiting, or abdominal
cramps.
LO 3
ISCHEMIC COLITIS
Sign and Symptoms
LO 4
DIVERTICULAR DISEASE
Diverticular Disease
• Consists of :
- Diverticulosis : the presence of diverticula
within the colon
- Diverticulitis : inflammation of a diverticulum
- Diverticular bleeding
Diverticulitis
• Diagnosis : left lower quadrant pain, rebound
tenderness (peritoneal involvement), fever,
leukocytosis
• Examination : abdominal tenderness or a mass
• CT :
- Thickening of the bowel wall
- Streaky mesenteric fat
- Associated abscess
Treatment
Treatment
LO 5
ANAL FISSURE
Anal Fissure
• A small tear or cut in the skin lining the anus
which can cause pain and/or bleeding.
• Typical symptoms : extreme pain during
defecation and red blood streaking the stool
• Acute fissure altered bowel habits or passing a
hard, dry bowel movement
• Chronic fissure poor bowel habits, overly tight
or spastic anal sphincter muscles, scarring or an
underlying medical problem
Treatment
• Bowel habits improved by changing to a
high fiber diet, adding fiber supplements,
using stool softeners when needed, drinking
plenty of fluids
• Topical nitrate (eg. Glyceryl trinitrate 0.2%
ointment) fissure has been present at least
3 weeks increases blood flow to the anus
and reduces pain on defecation
Treatment
• Topical calcium channel blockers (topical
diltiazem 2%) only if the use of topical
nitrates has not improved symptoms
• Botulinum toxin injected into the internal anal
sphincter paralyses the sphincter for several
months
• Surgery open lateral sphincterotomy, closed
lateral sphincterotomy, posterior midline
sphincterotomy
LO 6
ANGIODYSPLASIA
Angiodysplasia
• The finding of abnormal, ectatic, dilated,
tortuous and usually small (<10mm) blood
vessels visualised within the mucosal and
submucosal layers of the gut