Gastro Intestinal Bleeding Flashcards
Locations of GI bleeding
all parts of gastrointestinal tract
- oesophagus
- stomach
- small intestine
- large intestine (colon)
- rectum
- anus
Is GI bleeding a disease?
NO, it is a symtom of any number of conditions
Classification of GI bleeding
Upper GI bleeding
- pharynx to ligament of Treitz
Lower GI bleeding
- ligament of Treitz to rectum
upper GI bleeding 4 times more common than lower GI bleeding and is major cause of morbidity (unhealthy condition) and mortality (no. of death in a population)
What is Ligament of Treitz
It is a triangular double fold peritoneum that connects the duodenojejunal flexure to the right crus of diaphragm near the splenic flexure of colon
Causes of Upper GI bleeding
Common causes :
- peptic ulcers (duodenal & gastric ulcer) (45%)
- oesophageal varices (enlarged veins caused by liver disease and portal vein thrombosis) (20%)
- gastritis (20%)
- Mallory Weiss Tear/retching (tear of tissue in lower esophagus/ gastroesophageal junction ) by forceful coughng or long term vomiting (10%)
- gastric erosions (by NSAID or alcohol) (10-20%)
Uncommon causes :
- gastric carcinoma (5％)
- inflammation of GI lining from ingested material
- esophagitis
- pancreatitis
Causes of lower GI bleeding
- anal fissures (small tear in thin moist tissue inner lining of anus by contispation or passing large heard stool)
- haemorrhoids
- Diverticular disease (diverticulitis) – small bulging pouches by infection or inflammation on digestive tract
- colon cancer
- colitis
- arteriovenous malformations
- IBD (inflammatory bowel disease)
- infectious gastroenteritis
- polyps
- Meckels diverticulum (uncommon) – congenital anomaly of GI tract from incomplete oblietration of vitelline duct
Presentations of upper GI bleeding
Hematemesis
- Vomit of blood (from stomach/esophagus)
- coffee ground when gastric acid converts hemoglobin into methemoglobin
Melena
- Passage of black tarry stools
- Black color caused by hematin (product of oxidazation of Haem by intestinal and bacterial enzyme)
Hematochezia
- Passage of bright red blood from rectum in or with stools (from colon, rectum, anus)
- Brisk bleeding in upper GIT, bright red blood may come out unchanged in the stool
Symptoms upper GI bleed
1st appear :
- hematemesis
- melena
- hematochezia
- abdominal pain
associated symptoms with blood loss
- fatigue
- weakness
- pale skin
- shortness of breath
- abdominal pain
- vomiting of blood (originate from upper GI)
- bright red or maroon stool (originate from lower GI / brisk bleeding from upper GI source)
- long term GI bleeding go may go unnoticed / may cause fatigue, anaemia, black stools, positive test for microscopic blood
Signs and symptoms of Upper GI bleed
- hematemesis
- melena
- hematochezia
- syncope
- dyspepsia
- epigastric pain
- heartburn
- diffuse abdominal pain
- dysphagia
- weight loss
- jaundice
Presentations, Lab findings, Diagnostics of upper GI bleed
Presentations :
- anaemia
- chest pain
- syncope
- fatigue
- shortness of breath
Diagnostics :
physical examination
- vital signs (determine severity of bleeding and time of intervention)
- abdominal and rectal examination (determine possible causes of hemorrhage)
- assessment of portal hypertension and stigmata of chronic liver disease to determine bleeding is from a variceal source
Investigations of upper GI bleeding
- endoscopy (diagnostic)
- complete blood count with differential counts (CBC)
- haemoglobin level
- type and crossmatch blood
- basic metabolic profile, blood urea nitrogen, coagulation profile
- serum calcium level
- gastrin level
- chest radiography
- CT scan and USG (to find underlying cause)
Management of upper GI bleeding
due to advances in medications and endoscopy, upper GI hemorrhag is now treated without surgery
Initial assessment and management goals :
- assessment of statues of circulatory system and replace bood loss as necessary (ABC - airway, breathing, circulation)
- determine amount and rate of bleeding
- slow or stop bleeding by ice water lavage
- discover lesions responsible for episodes
- specific management for underlying causes :
— varices with endoscopic intervention or SEngstaken Blackomore balloon
— peptic ulcers with IV ppi infusion / endoscoic diathermy (heat to damage the tissue or like stop bleeding or cut tissue)
Summary of whole Upper GI bleeding
Signs and symptoms of lower GI bleeding (LGIB)
Varies with anatomical source of bleeding :
- maroon stools : +LGIB from right side of colon
- bright red stools per rectum : +LGIB from left side of colon
- melena : caecal bleeding
- CAN ALSO bright red stools per rectum : be +UGIB and right side colon bleeding if bleeding is brisk and massive
Management of LGIB
3 nonsurgical modalities to diagnose LGIB :
- colonoscopy
- proctosigmoidoscopy
- CT scan
- angiography
- barium enema (barium liquid pass into bowel and help to highight the bowel for x ray)
routine testing
- Blood test (Complete blood cell (CBC))
- Serum electrolyte level, blood urea (BUSE)
- coagulation profile : thrombin time (PT), platelet count, bleeding time
- cross matching
Treatment
- treat the cause
