UPPER GASTRO INTESTINAL BLEEDING

Personal Information

Name: Patient X Gender: Female Address: Block 5, Lot 1 Teleray Cabuyao, Laguna Age: 66 Date of Birth: April 11, 1944 Place of Birth: Pittlano Cabuyao Laguna Religion: Roman Catholic

Reason for Admission

Date Admitted: February 18, 2011 Time: 3:45 PM Vital Sign BP: 130/80 PR: 82 RR: 18 TEMP: 36.5

Chief Complaint:
Melena

Diagnosis or Impression:
Anemia secondary to Upper Gastro Intestinal Bleeding (UGIB)

Medical History
Few days PTA, patient noticed melena of stool + pale conjunctiva - abdominal pain - cyanosis - edema - soft abdomen

 

INTRODUCTION What is Anemia?

Anemia (uh-NEE-me-uh) is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't contain enough hemoglobin. Hemoglobin is an iron-rich protein that gives blood its red color. This protein helps red blood cells carry oxygen from the lungs to the rest of the body.

What is Upper gastrointestinal bleeding (UGIB)?

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.

Endoscopy revealed blood coming out from ampulla Fig 1a Axial section of Dual phase CT scan shows hyperdensity (white arrow) within the gallbladder 1b Flush aortogram shows origin of the right hepatic artery directly from the coeliac trunk and spasm in one of the branches (white arrow) 1 c Intraoperative picture shows multiple tubercles over the gallbladder (white arrow) and liver surface 1 d Histopathology sections (100) showing gallbladder mucosa (black arrow) with underlying epithelioid cell granuloma (white arrow).

 Anatomy of the Stomach

 Upper Gastro Intestinal Bleeding

 CAUSES 1.) Stomach ulcers 2.) Colon polyps 3.) Hemorrhoids 4.) Stomach bleeding 5.) Rectal bleeding 6.) Esophageal bleeding 7.) Intestinal bleeding

 Signs and Symptoms 1.) Blood in stool 2.) Black stool 3.) Rectal bleeding 4.) Anemia - ( pallor) 5.) Weakness

 Laboratory Reports: Hematology Form RESULT

Hemoglobin 83

NORMAL
M ( 140- 175) F (123-153)

Hematocrit .25

M ( .42- .50) F (.36- .45)

RBC 3.0

M (4.5 -5.9) F ( 4.1- 5.1)

WBC 7.6

Segmenters .76

.45 - .65

Lympocytes .23

.20 - .35

Monocytes .01

.02 - .05

 TREATMENT Emergency treatment Blood transfusions

 Treatment Blood Transfusion Date: 02/18/11 Time: 11: 45 PM PNRC 1 Unit of fresh whole blood type B RH positive Serial No. 2010-328427 Collection Date: 2/10/11 ExpirationDate:3/17/11 Units packed red cell concentrated blood type B RH positive 1 Unit whole blood type B RH positive

P SERIAL NO. A T H 2010- 286761 O P H 2010- 286765 Y S I 2010- 286762 O L O 2010-285741 G Y

Collection Date

Expiration Date:

02/15/11

03/22/11

02/15/11

03/22/11

02/15/11

03/22/11

02/10/11

03/17/11

 PATHOPHYSIOLOGY

 Medications:

Medicine
Esomeprazole

Indication
Treatment of Gastro Esophageal Reflux Disease (GERD )

Contraindication
Children less than 12 years old lactation

Sucralfate

Duodenal and Gastric Ulcers chronic gastritis

Patient on Dialysis

Paracetamol (Biogesic ) Tranexamic Acid

Relief of fever, minor aches and pain Treatment and prophylaxis of hemorrhage associated with excessive fibronolysis

Anemia, cardiac and pulmonary disease Patient with active intravascular clotting

Calcium Carbonate (Tums)

Relieve of acid in the digestion, heartburn, sour stomach and upset stomach associated

 Medications:

 Nursing Care Plan

Assestment Diagnosis Planning

Subjective: Nanghihina ako as verbalized by the patient Alteration to comfort related to Gastro intestinal bleeding Encourage patient to eat nutritious foods

Intervention Evaluation
To provide the nutrition to the patient need Goal met. After a day the patient feels good about herself and she was comfortabe on her bed

Objective: Weak in appearance restlessness Eat minimal amount but frequent She is at her 60 s so she need minimal but frequent serving of food ( slow digestion) To promote comfort and relaxation to the patient

Position the patient in comfortable way

 DIET: DAT
Diet as Tolerated