Index
Bleeding from any part of the digestive system is commonly known as gastrointestinal (GI) bleeding.
Gastrointestinal bleeding is one of the most common complaints that warrant consultation with a gastroenterologist (GI specialist).
Gastrointestinal bleeding can be classified into upper gastrointestinal bleeding and lower gastrointestinal bleeding.
The most common presentation for upper GI bleeding includes:
- Hematemesis (blood from vomit, which may be red or bright brown coffee grounds).
- Melena (black tarry stools).
- Hematochezia (if there is massive upper gastrointestinal bleeding of 1000 ml) although hematochezia usually presents lower gastrointestinal bleeding (usually colon).
Causes
Causes of upper gastrointestinal bleeding
The most common cause of upper gastrointestinal bleeding is peptic ulcer disease.
Peptic ulcer disease accounts for more than 50% of upper gastrointestinal bleeding.
The portal hypertension represents 10-20% of the upper gastrointestinal bleeding. The most common source of bleeding arises from esophageal varices in patients with cirrhosis due to chronic alcoholics and patients with chronic hepatitis.
Esophageal varices are the most common, but gastric and duodenal varices or portal hypertensive gastropathy may also be the source.
Mallory Weiss tears: Gastroesophageal junction laceration causes 5-10% of upper gastrointestinal bleeding. This condition is commonly seen in chronic alcoholics with retching.
Gastritis, esophagitis like GERD (gastroesophageal reflux disease), duodenitis, gastric cancer with ulcerative tumor, esophageal cancer with ulcerative tumor can cause upper gastrointestinal bleeding.
Vascular abnormalities such as angiodysplasia can also cause upper gastrointestinal bleeding.
The most common cause of upper gastrointestinal bleeding is ulcer disease.
Most upper gastrointestinal bleeds can present with hematemesis or melena. Massive rapid transit of high-volume upper gastrointestinal bleeding can also present with bright blood (hematochezia) in the stool.
Causes of lower gastrointestinal bleeding
Lower GI bleeding is defined as bleeding under the ligament of Treitz. That is from the last two-thirds of the duodenum to the anus.
However, 95% of the source comes from the colon. The most common presentation of lower GI bleeding is hematochezia (bright red bleeding). However, bleeding from ascending colon cancer can also present with melena.
Note that 10% of hematochezia can arise from upper gastrointestinal bleeding. The most common cause of lower GI bleeding is diverticulosis, which presents as colorless, painless bleeding.
The complete cause of lower GI bleeding is as follows:
Diverticulosis accounts for 50% of lower GI bleeds, which are generally seen in patients> 50 years of age, but are increasingly seen in younger patients.
Benign polyps and colon cancer account for 7% of lower gastrointestinal bleeding
Infectious colitis also causes lower gastrointestinal bleeding.
Angiodysplasia can occur in the upper and lower gastrointestinal tracts and therefore can present with melena and hematochezia.
Anorectal diseases, such as hemorrhoids and fissures, usually produce small amounts of bright red blood on the toilet paper, streaks in the stool, or leaks in the toilet bowl.
Hemorrhoids can be responsible for 10% of lower gastrointestinal bleeding.
Ischemic colitis is commonly seen in older patients with lower gastrointestinal bleeding. Most of them have atherosclerotic disease.
Most occur spontaneously due to a transient episode of non-occlusive ischemia of the intestine. They usually present with hemaochezia, but they can also be melena.
Inflammatory bowel disease especially ulcerative colitis often have diarrhea with a variable amount of hematochezia. Symptoms of tenesmus, abdominal pain, and sometimes fever may occur.
Clinical presentations of gastrointestinal bleeding
Most patients have orthostasis, which means an increase of more than 10 points in the pulse when moving from the supine position to standing.
Another definition will be the drop in SBP (systolic blood pressure) of> 20 points when sitting.
Treatment and diagnosis of gastrointestinal bleeding
Treatment will depend on the cause of the gastrointestinal bleeding.
The most important thing a doctor will do when you have gastrointestinal bleeding is check your vital signs. You will be given IV fluids if you have unstable vital signs, such as low blood pressure.
Once your doctor is sure that you are getting enough fluids to maintain your blood pressure, they will begin their diagnostic process to find the cause of the bleeding.
