International Journal of Research in Pharmacology and Pharmacotherapeutics
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1 44 Available Online at: Print ISSN : Online ISSN: (Research article) Find out the prevalance of various non-variceal diseases producing upper GI bleeding * 1 N.Junior Sundresh, 2 S.Narendran, 3 M.Ramanathan 1 Associate Professor of Surgery, Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. 2 Emeritus Professor of Surgery, Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. 3 Professor of Surgery Raja Muthiah Medical College & Hospital, Annamalai University, Chidambaram. ABSTRACT International Journal of Research in Pharmacology and Pharmacotherapeutics Non variceal upper G.I bleeding is the bleeding from a source proximal to the ligament of teres. Advances in medical technology particulars the increased availability and application or diagnostic and the operatic endoscopy have been instrumented in evaluated and successful treatment of patients with major bleeding. This study aims to find out various non-variceal diseases producing upper G.I. bleeds and the various modalities of treatment. Keywords: Non variceal upper G.I bleeding, hematemesis, Melena INTRODUCTION Upper GI bleeding is defined as bleeding from a source proximal to the ligament of teres. It is common and potentially deadly condition accounting for approximately 85% of hospital admissions for G.I. bleeding upper GI bleeding presents as hematemesis and it melena. Numerous advances in medical technology, particularly the improved availability and applications of diagnostic and therapeutic endoscopy have been instrumental in the evaluation and successful treatment of patients with major bleeding. The main aim of the study is, To find out the prevalence of various nonvariceal diseases producing upper GI bleed. To study the various modalities of treatment and also to study those cases which will require emergency surgery with special attention to endoscopy. To plan the mode of management with respect to non-variceal upper GI bleeding in the future. * Corresponding author: N.Junior Sundresh, Associate Professor of Surgery, Raja Muthiah Medical College & Hospital, Chidambaram. - Tamilnadu. E.Mail: juniorsundresh@yahoo.com
2 45.Materials and Methods Forty seven cases of upper bleeding were admitted during the period of 3 years of study in RMMCH, Chidambaram. As soon as the patient is admitted a detailed history is taken from the close relatives of the patient to understand the nature and amount of blood loss during the history taking itself. All relevant investigations were done. Results Out of the 47 patients, majority of cases (around 16) were from the age group years. Minimum age incidence was found in the age group years out of the 47 patients 36 were male and 11 were female, the male: female ratio being 3:1 the most common mode of presentation was haematemesis, and least was melena. Erosive gastritis was the most common etiological factor. Most of the cases were managed conservatively. Discussion The total of 47 patients studied, majority was in the age group of years with male prominence. Haematemesis is the predominant presenting symptom with the introduction of upper GI endoscopy. Source of bleeding can be detected in more than 90% of cases. The introduction of proton pump inhibitors and availability of easily endoscopic management has brought down the complication and need for survey in peptic ulcer disease. Through the necessity of emergency surgery has considerably reduced it is still preferred to be the important lifesaving produce for those patients who do not respond to conjunctive line of management. Table: 1 Age Incidence Age in Years No. of cases Percentage % % % % % % %
3 46 Table: 2 Sex Incidence Sex No. of cases Percentage Male % Female % Table: 3 Presenting Symptom Symptom No. of Cases Percentage Haematemesis % Melena % Haematemesis and melena % Table: 4 Presenting Symptom Lesions Identified No. of Cases Percentage Erosive gastritis % Duodenal ulcer % Gastric ulcer % Mallory Weiss tear % Carcinoma stomach % Dieulafoy s lesion % Necrotizing pancreatitis %
4 47 Table: 5 Diagnosis and Outcome Diagnosis No. of Cases Conservative Surgery Mortality Erosive gastritis % - - Duodenal ulcer % 20 % 10 % Gastric ulcer % - - CA stomach % - - Mallory Weiss tear % - - Dieulafoy s lesion % - - Necrotising Pancreatitis % - - REFERENCE 1. Gilbert, D.A. et al. "The National ASGE survey on upper Gl bleeding. III. Endoscopy in upper grastrointestinal bleeding" Gastrointest. Endosc. 27: Silverstein, F.G. et al. "The National ASGE Survey on UGI bleeding. I. Study design and baseline data". Gastrointest. Endosc : Eastwood, G.I. "Does the patient with upper GI bleeding benefit from endoscopy?" Dig. Dis. Sic : Savary, P.J., Miller et a. "Hand book and Atlas of Endoscopy" Atkinson, ML, Bottrill, M.B. and Edwards A.T., "Mucosal tears at the esophagus gastric junction: Gut 1961; 2: Jordan, S.M and Kiefer E.D. "Complications of peptic ulcer; their prognostic significance." JAMA 1934; 103: Mathewson K., Pugh, S., Northfield T.C. "Which peptic ulcer patients bleed?" Gut 1988; 29: Swain Paul, C. "Pathophysiology of bleeding lesions" Gastroinest. Endosc. 1990; 36: Hunt, P.S., Hansky, J., Korman, MG. "Mortality in patients with haematemesis and melena; a prospective study" Br. Med. J. 1979; 1: Karvoner, Al et al. "Gastric mucosal erosions: AN endoscopic, histological and functional study". Scand. J. Gastroenterol, 1983; 18: Somerville K et al. "Non-steroidal antiinflammtory drugs and bleeding peptic ulcer" Lancet 1986 ; 1: Lud et al. "Gastric aspiration in localization of gastrointestinal haemorhage" JAMA 1979; 241: Cottonm P.B. et a; "early endoscopy of oesophagus, stomach and duodenum in patients with haematemesis ad melaena." Arch. Surg. 1973; 197: Thomas G.E. et al. "Survey of management of acute upper GI haemorrhage." J.R. Soc. Med. 1978; 73: Foster et al. "Stigmata of recent haemorrhage in diagnosis and prognosis of upper GI he Br. Med. J. 1978, 1: Laurence, BH et al "Endoscopic laser photocoagulation for bleeding peptic ulcers". Lancet 1980; 1: Alam, P. et al "Randomised study of massive bleeding from peptic ulceration". Ann. Surg 1965; 162:
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