Mr.

Surya aged 55 years, came to the doctor's office with complaints of

defecation is black as asphalt since 2 days ago. On examination
found:
- Sens: CM weak
- BP: 100/70 mmHg
- HR: 100 beats per minute
- RR: 20 times per minute
- T: 37 C
- Palpebral conjunctiva was pale
- Tuse rectal examination results: black and brown stool softening
What happened to Mr. Surya and what actions are you doing?
1. Palpebral conjunctiva
the lower part of the eyelid

2. Tuse Rectal
digital rectal examination
1. Mr. Surya aged 55 years, complaints of defecation is black
as asphalt since 2 days ago
2. On examination found:
- Sens: CM weak
- BP: 100/70 mmHg
- HR: 100 beats per minute
- RR: 20 times per minute
- T: 37 C
- Palpebral conjunctiva was pale
3. Tuse rectal examination results: black and brown stool softening
1. - A disturbance in the digestive tract
- There is bleeding in the digestive tract
2. palpebral conjunctival pallor, low blood pressure, sens: CM
weak => Anemia
3. Stool blackish brown and mushy => bleeding in the
gastrointestinal tract which mixes with stomach acid (HCL)
Mr. Surya 55 y.o suspected upper gastrointestinal tract
bleeding is characterized by major symptoms such as blackish
brown stool
1.1 definition of Bleeding Channel Eat
Gastrointestinal Bleeding is bleeding from gastrointestinal
that can arise as hematemesis, melena, rectal bleeding, and
anemia.
a. Upper Gastrointestinal Bleeding
Upper Gastrointestinal Bleeding is bleeding from the
proximal part of the ligament of treitz.
b. Lower Gastrointestinal Bleeding
Lower Gastrointestinal Bleeding is generally defined as
bleeding from the colon next to bottom of the ligament of
treitz.
1.2.1 Upper Gastrointestinal Bleeding
Some causes of the incidence of bleeding
in the upper dining channels include:

A. Abnormalities in the esophagus

1. esophageal varices Rupture
2. Carcinoma of the
esophagus
3. Mallory Weiss Syndrome
4. Esofagogastritis korosiva

B. an abnormality in the stomach

1. Gastritis erosiva hemoragika
2. peptic ulcers
3. Carcinoma of the stomach

C. an abnormality in the duodenum

1. the ulcer duodeni
2. Carcinoma of the papilla vaterii
1.2.2 lower Gastrointestinal Bleeding
a. As causes of pseudo melena, among others
1. complications of abdominal typhus
2. Carcinoma of the colon ascendens
3. Ileitis terminalis
b. causes of hematokezia:
1. ulcerative colitis
2. Tumor in the colon
3. Haemorrhoids
4. Divertikulosis in the colon
5. Angiodisplasia in the colon
6. crohn's disease in colon
 Upper Gastrointestinal bleeding is a medical problem that often cause a high
mortality, therefore must be considered a serious problem, and need appropriate and
immediate handling carefully.
The incidence of Upper Gastrointestinal bleeding between 47-116 per 100,000
population. In the UK approximately 2500 patients are hospitalized each year
because of the PSMA. The highest incidence was seen in the low socio-economic
communities.
PSMA in men 2 times more often than women in all age groups. Description at
Gatot Subroto over the next 5 years (2002 2006) found 248 (70,45%) men and 104
(29,56%) women who experienced the PSMA, which age groups 61 70 year high
prevalence.
In Indonesia because of bleeding varices ruptura gastroesofagei that is the cause of
about 50 60%, gastritis erosiva hemoragika about 25 30%, peptik an ulcer
around 10 15% and due to other reasons < 5%.
 UPPER GI BLEEDING
1. Esophageal varices
2. Mallory-Weiss syndrome
3. Esophagitis and Esophageal Ulcers
4. Esofagogastritis Korosiva
5. Hemorrhagic gastritis Erosiva
6. Peptic ulcer
7. Carcinoma of the papilla Vaterii
 LOWER GI BLEEDING
1. diverticulitis
2. Chorn's Disease
3. Ulcerative colitis
4. Hemorrhoid
5. Colorectal Cancer
1. Hematemesis
Vomiting blood and indicates upper gastrointestinal bleeding, red or brown
"coffee ground".
2. Melena
Droppings (feces) due to dark stool with stomach acid; usually indicates a
portion upper gastrointestinal bleeding, or bleeding than the intestines or colon
may also be right Courant other sources. Accompanied by symptoms of
anemia, namely: dizziness, syncope, angina or dyspnea.
3. Syncope
Syncope is a temporary loss of consciousness followed by the return of full
alertness.
4. Dyspnea
The feelings are subjective form of difficulty (feeling unwell, feeling
uncomfortable) when breathing.
5. Hematochezia
Bleeding from the rectum as a result of lower gastrointestinal tract bleeding,
but may also be due to upper gastrointestinal bleeding that is heavy.
1. ANAMNESIS
the patient's Identity: Name, occupation, address, status, age, education.
the main complaint: The Black colored bowel movements (melena)
additional Complaints: Vomiting violently vomiting blood, and palpebral
conjunctiva pale epigastric pain, nausea, vomiting, bloating, diarrhea etc.
present disease History:
Complaints Black-colored bowel movements:
first disease History:

2. PHYSICAL EXAMINATION
A. INSPECTION
B PALPATION.
C. PERCUSSION
D. AUSCULTATION
4. SUPPORTING INVESTIGATIONS
a) Laboratory Examinations
b) NGT (Naso Gastric Tube)
c) Endoscopy
d) examination esofagogastroduodenoskopi
e) radiological Examination

5. APPELLATE DIAGNOSIS.
a. Lower GIT Hemorragik (bleeding under cerna channels)
b. Esophageal Varices
c. Esophagus Cancer
d. Cancer Gaster
e. Gastric Outlet Obstruction
f. Abdominal Aortic Anaeurysm
For high-risk patients need more aggressive measures such as:
1. Installation of at least 2 IV line with a needle (catheter) is
large at least no 18. It is important for transfusion purposes.
Recommended installation of CVP
2. Oxygen hoods / kanula.Bila no interference needs to be
installed ETT AB
3. Noting intake output, urinary catheter should
4. Monitor blood pressure, pulse, oxygen saturation and other
circumstances in accordance with existing comorbid.
5. Perform gastric lavage in order to facilitate the endoscopic
measures. In implementing this common action, the patient can be
given therapy
6. Transfusion to maintain hematocrit> 25%
7. Administration of vitamin K
8. Synthesis of gastric acid-suppressing drugs (PPIs)
9. Other therapies in accordance with comorbid. Of patients strongly
suspected gastroesophageal varices can rupture because given
Octreotide 50 mcg bolus followed by a drip of 50 mcg every 4 hours.
A. Oesophageal Varices
1. Medical therapy with nonselective betabloker
2. Therapeutic endoscopy with sclerotherapy or ligation

B. Peptic Ulcer
1. Gastric ulcers PPI for 8-12 weeks and 6-8 weeks of PPI duodeni ulcers
2. If there needs to be eradicated pilory helicobacter infection
3. When patients require NSAIDs, analgesics and replaced first by then been
selective NSAID + PPI or misoprostol
Complications of upper gastrointestinal bleeding can be
derived from the treatment is done, such as:
Endoscopy
o Pneumonia aspiration
o Perforation
o Complications of coagulation, laser penogbatan
Surgery
o ileus
o Sepsis
o Problem wounds
Surgery for severe patients with continuous bleeding
associated with a high mortality rate.
Deaths
Failure Chronic liver cirrhosis
Elderly patients and those with chronic illnesses experienced
upper gastrointestinal bleeding have a higher mortality risk
factors. Approximately 7% mortality rate in patients with
PSMA. Patients who experience bleeding while in hospital for
other diseases has a mortality rate of 26%.
Mr. Surya 55 y.o of suffering Upper GI Bleeding. Treatment
given was:
1. Initial therapy : Do common actions (ABC)
2. Investigations, such as:
- full blood examination
-Nasogastric Tube
-Endoscopy