O. N. M. Panton, MB, BS, FRCSC, FACS,
Head, UBC Division of General Surgery,
VGH/UBCH
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HAEMORRHAGE
SEPSIS
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Upper GI
Small Bowel
Colorectal
Solid organ
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Gastric or duodenal ulcer
Varices
Mallory-Weiss tear
Oesophageal ulcer
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Varices
Mallory-Weiss tear
Esophagitis/ulcer – acid reflux, infection
Neoplasia
Trauma
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Gastritis
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Superficial
Stress ulceration
Mechanical
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Gastric Ulcer
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Benign or malignant
(10%)
Initial biopsy if safe
Repeat OGD to assess
healing & repeat bx
Benign: drug-induced,
hypersecretors +/- H.
pylori infection
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Duodenitis
Benign ulcer
Crohn’s
Neoplasia
Vascular Malformation
Dieulafoy
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Haemobilia
Aortoduodenal fistula
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Benign ulcer
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May have all the
same etiology as
stomach
Major bleeding
usually
gastroduodenal
artery
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32 year old male found at home in a pool of
blood & still vomiting blood
VGH ER pulse140 BP 60/0
Hb 32
Massive resuscitation/transfusion protocol
Codes x 2 in ER
OGD bleeding ++++
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OR STAT laparotomy
Codes shortly after laparotomy
Duodenotomy/gastrotomy
Watermelon stomach torrential haemorrhage
Blood gushing from duodenum
Died on table
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Angiodysplasia
Diverticular disease
Neoplasia: Adenocarcinoma, GIST’s
Ischemia
Hemmorhoids
IBD
Infection: Campylobacter, Shigella, Salmonella,
Enteropathogenic E. coli
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Acute bleeding occurs in 20-30 cases/100,000
annually
20-30% of GI bleeds
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67 year old female found down at home in a
pool of blood passed per rectum
VGH ER pulse 156 BP 50/0 Hb 36
Resuscitated/massive transfusion protocol
Previous LAR/TME rectal ca neoadjuvant
short course radiorx
Leak/Hartmann
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STAT OR
Pre-sacral ulcer communicating with rectal
stump
Packed/controlled
ICU plan for IR angio/embolization
DIC ICU & died
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56 year old male presents VGH ER sudden (R)
flank pain
Pulse 148 BP 210/110 Hb 88
Resuscitated then STAT laparotomy
(R) suprarenal ruptured tumour
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Perforated appendicitis
Colonic perforations
Gasrtro-duonenal perforations
Mesenteric ischaemia with infarcted gut
Gangrenous cholecystitis
Necrotizing pancreatitis
Ascending cholangitis
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47 male HIV + 24 hour hx severe abdominal
pain
CT dx terminal ileitis Rx IV antibiotics
GS consulted next night
Temp 39 pulse 120 BP 115/68
Generalized peritonitis WBC 18 creatinine 110169
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DL RLQ abscess
Laparotomy: gangrenous
appendicitis/faecolith
Appendectomy & drainage of abscess