Group 1
Fadzliana
Yamuna
Atirah
Siti Rohani
Hematemesis - Vomiting of bright red blood
usually represents bleeding proximal
to the ligament of Treitz
Hematochezia - Bright red blood per rectum
indicates a lower GI source of bleeding
Blood has a laxative effect so with massive
bleeding the stool may be bright red
Blood streaks on the stool indicates anal
outlet bleeding
Blood mixed with stool indicates bleeding
source higher than the rectum
Blood with mucus indicates an infectious or
inflammatory disease
Currant jelly-like material indicates vascular
congestion and hyperemia (intussusception
or midgut volvulus)
Maroon-colored stools indicate
voluminous bleeding proximal to the
rectosigmoid area
Melena, passage of black, sticky (tarry)
stools suggests upper GI tract
bleeding, but can be as distal as the
right colon
Hematemesis suggests a large bleed
with possible recurrence, melena alone
indicates less voluminous bleeding
Common Less Common
Nasopharyngeal Bleeding disorders
bleeding
Duplication cyst
Erosive
Esophagitis Foreign body
Peptic ulcer Tube trauma
Gastritis (H. pylori) Vascular malformation
Mallory-Weiss tear Esophageal varices
Prolapse
gastropathy
Common Less Common
Anal fissure
Infectious colitis Meckel’s diverticulum
Salmonella, Shigella, Duplication cyst
Campylobacter, Hirschsprung’s enterocolitis
C.diff Gangrenous intestine
Inflammatory bowel Vascular malformation
disease
Intussusception
Upper GI source
Neonates
• Most common causes of apparent neonatal GI
bleeds include bacterial enteritis, milk protein
allergies, intussuseption, swallowed maternal
blood, anal fissures, and lymphonodular
hyperplasia.
• Erosions of the esophageal, gastric, and duodenal
mucosa are also a frequent cause for true neonatal
GI bleeding.
• Some drugs are implicated in neonatal GI bleeds:
NSAIDs, heparin, and tolazoline, which are used for
persistent fetal circulation.
Indomethacin, used for patent ductus arteriosus
Infants
• GI mucosal lesions and irritations are the most
common causes of GI bleeding in infants and
children. This category includes esophagitis,
gastritis, duodenitis, ulcers, colonic polyps,
and anorectal disorders.
• Intussusception is a frequent and important
etiology of GI bleeding in this age group
• Other causes include infectious diarrhea,
midgut volvulus, Meckel diverticulum,
arteriovenous malformation
Children
Duodenal ulcer, Mallory-Weiss tear, and
nasopharyngeal bleeding are important causes of
bleeding in older children.
Juvenile polyps also occur frequently in children of
the age group between 2 and 8 years old (with a
peak from 3-4 years) causing painless rectal
bleeding usually from polyps in the rectosigmoid
region
Helicobacter pylori has been associated with peptic
ulcer disease in children. However, H pylori
infection is common and usually asymptomatic.
Acute gastrointestinal bleeding first will appear as
vomiting of blood, bloody bowel movements, or
black, tarry stools. Blood may look like "coffee
grounds."
Symptoms associated with blood loss can include
the following:
Fatigue
Weakness
Shortness of breath
Abdominal pain
Pale appearance
Upper GI tract Lower Gl tract
Common signs: Common signs:
Hematemesis Hemaochezia is usual
although an upper GI
(clear indicator) lesion may bleed
melena rapidly that blood does
melena or not remain in the
hematochezia with intestine long enough
hemodynamic instability for melena to develop
The test used most often
to look for the cause of
GI bleeding is called
endoscopy
Used to identify the
source of bleeding
A type of endoscopy
called colonoscopy looks
at the large intestine.
Our endoscope is broken, but
luckily nurse has her mobile phone
camera – it’s quite small…
Diagnosis is often based on direct
observation of blood in the stool. This can
be confirmed with a fecal occult blood test.
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.
Fluid resuscitation
intravenous fluids and blood transfusion may be administered.
Acid suppression:
in an upper GI source, proton pump inhibitors reduce gastric acid
production and enhance healing of bleeding lesions.
Inhibition of fibrinolysis:
in ongoing bleeding, tranexamic acid reduces fibrinolysis and may
decrease blood product requirements.
Correction of coagulopathy:
if coagulation parameters (e.g. prothrombin time) are deranged,
vitamin K or fresh frozen plasma may need to be administered.
Reduction of portal pressure:
if the bleeding is thought to be due to esophageal
varices (a complication of cirrhosis of the liver),
vasopressin analogues and rarely octreotide may be
administered. Rarely, a Sengstaken-Blakemore tube
may be inserted to mechanically compress varices.
Urgent endoscopy:
if the bleeding cannot be managed medically an
urgent esophagogastroduodenoscopy (EGD/OGD) may
identify sources of bleeding. This is a high-risk
procedure best performed under safe circumstances in
the intensive care unit or operating theatres.
Surgical intervention:
in extreme cases of bleeding, laparotomy may be
required to identify the bleeding source.
Esophagogastroduodenoscopy (EGD/OGD)
