Siddhi clinic

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Esophageal causes (gastrorrhagia):

• Esophageal varices
• Esophagitis
• Esophageal cancer
• Esophageal ulcers
• Mallory-Weiss tear

Gastric causes: 

• Gastric ulcer
• Gastric cancer
• Gastritis
• Gastric varices
• Gastric antral vascular ectasia

Dieulafoy's lesions

• Duodenal causes
• Duodenal ulcer
• Vascular malformation, including aorto-enteric fistulae
• Hematobilia or bleeding from the biliary tree
• Hemosuccus pancreaticus or bleeding from the pancreatic duct
• Severe superior mesenteric artery syndrome

The signs and symptoms of upper gastrointestinal bleeding are as follows:

• Hematemesis - Vomiting of blood
• Melena - Blood in the stool
• Hematochezia - Passage of fresh blood through the anus, usually in or with stools
• Syncope - Loss of consciousness (fainting)
• Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
• Dyspepsia – IndigestionEpigastric painHeartburnDiffuse abdominal pain
• Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discoloration of the skin, mucous membranes, and sclera

The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

• Orthostatic blood pressure
• Complete blood count with differential counts
• Hemoglobin level
• Type and crossmatch blood
• Basic metabolic profile, BUN,
• Coagulation profile
• Serum calcium
• Serum gastrin
• Endoscopy
• Chest radiography
• Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)

Upper gastrointestinal bleeding can be managed in the following ways:

• Airway management and fluid resuscitation using either intravenous fluids and or blood
• Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
• Surgical intervention
• Treating the consequences (like anemia) that the bleeding may have caused
• Precautions are taken to prevent rebleeding

Polycystic Ovarian Syndrome or Disease (PCOS) is a very common condition, wherein there are multiple cysts in the ovaries. As a result, there are many changes which the body undergoes and it is not limited to the gynecologic system. A woman with PCOS may also find it difficult to conceive, and so, once she is pregnant, precautions are essential to ensure there are no complications.

Pcos predisposes women to diabetes, hypertension, obesity, cardiovascular complications, lipid metabolism disorders, uterine cancer in long run. Some of them are listed below:

1. Preeclampsia: When the blood pressure readings are high during pregnancy, it is known as preeclampsia. It brings with it a whole lot of complications including the need to cesarean section, premature birth, etc. So, it is best avoided, and diet can help to some extent.
2. Diabetes: Gestational diabetes which manifests as higher sugar levels only during the pregnancy is very common in women with PCOS. The increased hormone levels in PCOS increase insulin resistance, thereby increasing sugar levels. This needs to be managed through a combination of diet, exercise, and lifestyle changes.
3. Preterm labor: Women with PCOS are at a slightly higher risk of premature labor.
4. Weight-related issues: PCOS leads to weight gain, and this could be a problem during pregnancy. It is essential to discuss with the doctor as to what would be a good weight range and stay within that range throughout pregnancy. Weight gain brings with it a host of complications and so best avoided.

Dietary changes:

With PCOS, during pregnancy, strict cautious diet planning can help in avoiding complications and allow for an easier pregnancy. Though they may not solve every problem associated with PCOS, dietary modifications can have a significant effect on the overall health and well-being. Listed below are some easy-to-make changes:

1. Increase consumption of fibres like greens, nuts, pumpkin, berries, whole grains, almonds, etc. are included. This ensures that digestion is a prolonged and gradual spike in blood sugar levels.
2. Increase protein-rich foods like soya, tofu, eggs, and chicken, which help in avoiding binging. They are light on the stomach and help in weight management.
3. Foods which are generally anti-inflammatory including tomatoes, olive oil, spinach, fresh fruits, and omega-3 fatty acids help in controlling blood pressure and cholesterol levels.
4. Supplements to include omega-3 fatty acids, prenatal vitamins, vitamin D, and calcium if required ensure that the baby gets the required nutrients for optimal growth.

What to avoid:

Anything that can spike up calories and is of low nutritional value should be avoided.

1. Avoid whites – pasta, rice, and bread
2. Baked and processed foods
3. Candies, chocolates, snacks
4. Salty and spicy fried snacks
5. Aerated drinks and soda

PCOS in pregnancy presents a combination risk, and dietary changes and weight management are essential for a safe pregnancy.