An unfortunate news.

Today I'd received a shocking news from a close family members of mine: informing me that my uncle was admitted to RIPAS Hospital last night with complaints of having headache, vomiting, bloody stool and abdominal pain. He was rushed to RIPAS Hospital Accident & Emergency Department (A&E)  for immediate treatment and management sometime around 11pm. 

He was then diagnose by the M.O with Anemia and Upper Gastrointestinal Bleed (GI Bleed) which requires him to be admitted in the hospital. Tho' Anemia - low amount of red blood cells (RBC) or platetes are common when someone's bleeding internally or superficially. However, if  there is no immediate treatment and management being done such as a blood transfusion, it can become fatal. 

But Anemia is NOT the one that I want to focus on for today. What I really want to focus on is about the GI Bleed - Gastrointestinal Bleed. Let me elaborate furthermore regarding this. 

Upper gastrointestinal (GI) bleeding refers to hemorrhage in the upper gastrointestinal tract. The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon.

Upper GI bleeds are considered medical emergencies, and require admission to hospital for urgent diagnosis and management. Due to advances in medications and endoscopy, upper GI hemorrhage is now usually treated without surgery.

There are many causes for upper GI hemorrhage. Causes are usually anatomically divided into their location in the upper gastrointestinal tract.

Patients are usually stratified into having either variceal or non-variceal sources of upper GI hemorrhage, as the two have different treatment algorithms and prognosis.

CAUSES:

Esophageal causes:

• Esophageal Varices
• Esophagities
• Esophageal Cancer
• Esophageal Ulcer

Gastric causes:

• Gastric Ulcer
• Gastric Cancer
• Gastritis
• Gastric Varices
• Gastric Antral Vascular Ectasia aka Watermalon stomach
• Dieulafo's lesions
  

 Duodenal causes:

•        Vascular malformations, including aorto-enteric fistulae. 
•     Fistulae are usually secondary to prior vascular surgery and usually occur at the proximal anastomosis at the third or fourth portion of the duodenum where it is retroperitoneal and near the aorta.
•     Hematobilia, or bleeding from the biliary tree 
•     Hemosuccus pancreaticus, or bleeding from the pancreatic duct 
•     Duodenal Ulcer

Treatment:

Emergency treatment for upper GI bleeds includes aggressive replacement of volume with intravenous solutions, and blood products if required. As patients with esophageal varices typically have coagulopathy, plasma products may have to be administered. Vitals signs are continuously monitored.

Early endoscopy is recommended, both as a diagnostic and therapeutic approach, as endoscopic treatment can be performed through the endoscope. Therapy depends on the lesion identifies, and can include:

•     Injection of adrenaline or other sclerotherapy  electrocautery.
•     Electrocautery
•     Endoscopic clipping or banding of varices.

With Love: Amirul010