Gastrointestinal bleeding

Gastrointestinal bleeding
Gastrointestinal bleeding
PosFOB.JPG

A positive fecal occult blood test
ICD-10 K92.2
ICD-9 578.9
DiseasesDB 19317
MedlinePlus 003133
eMedicine radio/301 radio/302 emerg/381
MeSH D006471

Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage (loss of blood) in the gastrointestinal tract, from the pharynx to the rectum. It has diverse causes, and a medical history, as well as physical examination, generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding.

Initial emphasis is on resuscitation by infusion of intravenous fluids and blood transfusion, treatment with proton pump inhibitors and occasionally with vasopressin analogues and tranexamic acid. Upper endoscopy or colonoscopy are generally considered appropriate to identify the source of bleeding and carry out therapeutic interventions.

Contents

Definition

Gastrointestinal bleeding can range from microscopic bleeding, where the amount of blood is so small that it can only be detected by laboratory testing (in the form of iron deficiency anemia), to massive bleeding where pure blood is passed and hypovolemia and shock may develop, risking death.

Cause

The causes of upper GI bleed is different from that for lower GI bleeds.

Differential diagnosis

Gastrointestinal bleeding can be roughly divided into two clinical syndromes.

Upper gastrointestinal

Upper gastrointestinal bleeding is from a source between the pharynx and the ligament of Treitz. An upper source is characterised by hematemesis (vomiting up blood) and melena (tarry stool containing altered blood).

Lower gastrointestinal

Lower gastrointestinal bleeding may be indicated by red blood per rectum, especially in the absence of hematemesis. Isolated melena may originate from anywhere between the stomach and the proximal colon.

Diagnostic approach

Diagnosis is often based on direct observation of blood in the stool. This can be confirmed with a fecal occult blood test.

Treatment

Initial focus in any patient with a form of gastrointestinal hemorrhage is on resuscitation, as any further intervention is precluded by the presence of intravascular depletion or shock.

Endoscopy

After adequate stabilization, endoscopy (upper endoscopy and/or colonoscopy) are used to identify the source of bleeding. Injection, sclerotherapy, electrocoagulation, vascular clipping and biopsy may be performed.

Endoscopy is also useful in setting the indication for therapy, e.g. the need for long-term proton pump inhibitor therapy, presence of esophageal varices, adenomatous polyps and so on.

References

  • Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J 2002;78:4-14. PMID 11796865.

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