Gastro-Intestinal Bleeding its causes and its treatment

* Upper GIT bleeding:

- Site of bleeding: is proximal to ligament of Treitz. (distal

duodenum)

- Presentation: - Haematemesis

- Melaena

- Occult blood in stool

* Lower GIT bleeding:

- Site of bleeding: is distal to ligament of Treitz.

- Presentation: - Heamatochezia (Bleeding per rectum)

- Melaena

- Occult blood in stool -

Haematemesis:

- Vomiting of blood

- Blood may be:

· red in color: if immediately after bleeding

· coffee ground (Melenemesis): when blood is in contact

with gastric acid for at least 1 hour.

* AE: Esophageal:

- Esophageal varices - cancer – Esophagitis

- Mallory – weiss tear

* Gastro-duodenal:

- Duodenal ulcer

- Gastric ulcer

- Gastritis

- Cancer stomach

* Systemic (general) causes:

- Haemorrhagic blood diseases.

- Haemorrhagic fever.

- Severe hypertension.

- Heparine therapy.

Mallory – weiss tear: mucosal tear due to repeated vomiting.

ttt : self limited, vasopressin may be used

*** D of haematemesis:

1- Clinical history:

Cause Question to detect I cause

1- O. varices

2- Peptic ulcer

3- Gastritis

4- Cancer stomach

5- Mallory-weiss

6- Coagulation defect

History of cirrhosis, confusion?

Epigastric pain, dyspepsia, heart burn?

History of drug intake e.g: Aspirin,

Alcohol, NSAID?

Epigastric pain?

Weight loss, Meat dyspepsia

Preceded by severe vomiting?

Oral anticoagulant?

History of cautaneous or orifice

bleeding?

2- Nasogastric tube: usually +ve for blood

3- Endoscopy to localize i site of bleeding.

4- Angiograpy: done if endoscope fails to show i site of bleeding.

5- Lab: Aneamia

­­ urea: (breakdown of blood)

* v of heamatemesis:

1- Resuscitation: IV fluid & blood transfusion if necessary.

2- Endoscopy

3- v of i cause: e.g: O. varices: 

peptic ulcer: IV omeprazole.

4- Iron therapy: given in chronic cases presenting with iron

deficiency anaemia.

D D of haematemesis:

- differentiation of i cause

- Heamoptysis

- False haematemesis: Ingestion of blood after bleeding from i

nose, mouth or pharynx then vomiting of this blood.

Melaena:

- Passage of black tarry stool due to presence of digested

blood.

- It indicates that heamorrhage has remained for ≥ 8 hours in

the GIT

* AE:

Site of bleeding: is not merely above ligament of Treitz but may

extended up to right colon.

So, AE of melaena =

i- AE if upper GIT bleeding (heamatemyesis)

ii- Jejunum & ileum: 2T + 2C

· Typhoid ulcer

· T.B enteritis

· Cancer head of pancrease

· Crohn's disease

iii- Colon:

· Rhight sided tumor

· Ulcerative colitis.

D D of dark stool:

- melaena

- Iron ingestion

- haemolytic Jaundice.

* Diagnosis & v of melaena; The same as

haematemesis

Haematochezia:

- Passage of bright red blood per rectum.

- Usually indicate that lesion distal to Rh. Colon

* AE:

- Hemorrhoids

- Diverticulosis.

- Colitis

- Colonic Cancer: usually present with chronic occult bleeding.

D of Haematochezia:

1- Clinical history

2- PR examination

3- Colonoscop

4- Barium enema

5- Nasogastric tube: -ve

6- Lab: Aneamia

Occult GIT blood loss:

- normal appearing stool

- hemoccult +ve

N.B: C/P of GIT hge:

1- C/P of i type of hge.

2- Hypovolemic shock

3- Recurrent GIT hge ® lead to iron deficiency anaemia.

4- C/P of i aetiology