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Pt with upper GIT bleeding (Hematemesis)
📍IV line +Send full investigation &cross matching)
📍Check vital signs
If decrease BP: give N/S 500 ml over 30 min
If decrease RBS: give DNS
if decrease BP &RBS: give NS, DNS
📍Prepare blood for trans,
FFP or Fresh blood after blood grouping & cross matching
📍for bleeding
Tranexamic acid 1g vial
Dicynone 1 g vial
Octerotide 50 mcq Iv bolus then 500mcg in side 50 cc NS by 2.5 ml/hr(25- 50 mcg/hr) for 2-5 d
📍Pantoprazole 80mg IV TDS
📍Emest 8 mg IV
📍Duphlac 30ml TDS then acc to bowel motion
📍Abx according to pt
*with ascites
Cefotaxime 1g TDS + Rifaximine 200 mg tab TDS
*without ascites
cefotaxime 1g or Ceftriaxone 1g
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ماذا لو جاء احدهم يشتكي لك من Upper git bleeding 🤔
استقبل الحاله واسألهه اسئله مركزه وسريعه وبنفس الوقت تكون تشيك ع المريض examinationوخاصة vital signs وتقيم المريض لاي مرحله وصل بخصوص shock
تبدا له management وبشكل فوري والي يهمك فيه ثلاثه اشياء
▶️stop of bleeding
▶️replacement fluid loss
▶️determinde the underlying cause
تبدا بالinitial treatment
و يكون ع الشكل التالي ↪️
▪NS 500ml
▪️pantoperazole 80mg Iv bolus
▪️Tranexamic acid 1g in 100ns over 10 minutes
▪️Octerotide 50mcg IV bolus
▪️Emest 8mg
وبنفس الوقت انت ترسله للinitial Ix ↪️
CBC ,PT,PTT,INR, RFT, S.E ,LFT
and cross matching
بالوقت اللي العلاج يمشي بتكون تنتضر نتايج الفحوصات توصل
وبعدين ع حسب نتايج الفحوصات وحالة المريض clinical
بنهاية المطاف لمن تتاكد انه المريض stabilize بمعنى النزيف توقف والعلامات الحيوية كويسه
الان تقدر تتكلم ع موضوع desposition
الي هو هل المريض حق admitted or discharge
هل urgent endoscopy or not
وهكذا
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اشهر خمس سيناريوهات فى حالة upper git bleeding
-Esophageal varices
-Bleeding peptic ulcer
-Mallory -weiss tear
-Gastric carcinoma
-Slow upper GI bleeding
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🧠 UPPER GIT BLEEDING
Mnemonic for causes of upper
GIT bleeding
#Remember : VARICES
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🔆كيف افرق اذا ما كان السبب لل upper GIT bleeding
#peptic_ulcer او #varices
من خلال hematomesis 🤔⁉️
#peptic_ulcer
🔺amount of blood: small
🔺color: like coffee
🔺pain: painful
🔺shock.: +
🔺Recurrent: +
➖➖➖➖➖➖➖➖➖➖➖➖
#varices
🔺amount of blood: large
🔺color: fresh blood
🔺pain: painless
🔺shock.: ++
🔺Recurrent: +++
#Internal_medicine_Hepatology
#level_4
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hiatal hernia occurs when part of the stomach pushes upward through the diaphragm (the muscle that separates the chest from the abdomen) into the chest cavity.
Types
Sliding hiatal hernia (most common)
The stomach and the junction between the esophagus and stomach slide up into the chest.
Often associated with acid reflux.
Paraesophageal hiatal hernia
Part of the stomach pushes through the diaphragm beside the esophagus.
Less common but can be more serious because the stomach can become trapped.
Diagnosis
using:
Upper endoscopy
Barium swallow X-ray
Esophageal manometry
Treatment
Lifestyle changes
Eat smaller meals
Avoid lying down for 2–3 hours after eating
Lose excess weight if needed
Elevate the head of the bed
Avoid trigger foods (fatty foods, caffeine, alcohol, spicy foods)
Medications
Antacids
H2 blockers
Proton pump inhibitors (PPIs)
Surgery
Considered for severe symptoms, complications, or large paraesophageal hernias.
Common procedure: laparoscopic repair, often with fundoplication.
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+2
✍Foley catheter sizes
✍Laryngoscope blade sizes
✍ET tube sizes
رابط القناة 👇👇👇👇👇
https://t.me/Kameldgshd675
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❇️ RULE OF NINES (ADULT)
• The Rule of Nines is a rapid clinical method used to estimate the Total Body Surface Area (TBSA) involved in burns in adults
• It helps in burn severity assessment, fluid resuscitation, triage, and burn center referral
Body Surface Area Distribution (Adults)
• Head and neck → 9%
• Each upper limb → 9%
• Anterior surface → 4.5%
• Posterior surface → 4.5%
• Anterior trunk (chest + abdomen) → 18%
• Posterior trunk (back + buttocks) → 18%
• Each lower limb → 18%
• Anterior surface → 9%
• Posterior surface → 9%
• Perineum / genitalia → 1%
How
• Assign the corresponding percentage to each area
• Add all values
• TBSA (%) = Sum of all burned area perce burn severity
• Guides IV fluid resuscitation
• Assists in triage decisions
• Helps decide burn center referral
Role in Fluid Resuscitation
• Parkland Formula
• 4 mL × body weight (kg) × % TBSA burned
• 50% given in first 8 hours
• Remaining 50% over next 16 hours
