GASTROINTESTINAL BLEEDING
Dr. Daniel Asiimwe
SURGERY DEPARTMENT
• We classify them into Acute and Chronic
• The causes of gastrointestinal (GI) bleeding are
classified into upper or lower, depending on
their location in the GI tract.
• Upper gastrointestinal bleeding is from a
source between the pharynx and the
ligament of Treitz.
• An upper source is characterised by
haematemesis (vomiting up blood) and
maelena (tarry stool containing altered blood).
• Types of causes include: infections, cancers,
vascular disorders, adverse effects of
medications, and blood clotting disorders
• Peptic ulcers
• Gastritis
• Oesophageal and gastric erosive varices
• Gastric cancers
• Inflammatory conditions eg poisoning or any
other ingested materials
Chronic
• Oesophagitis, gastritis
• Peptic ulcers
• Oesophageal /Gastric neoplasia:
Signs and symptoms
. Blood that is digested may appear black rather
than red, resulting in "coffee ground" vomitus
or maelena stools.
• A number of foods and medications can turn
the stool either red or black.
• Bismuth found in many antacids may turn
stools black as may activated charcoal.
• Blood from the vagina or urinary tract may
also be confused with blood in the stool
Diagnosis
• is often based on direct observation of blood
in the stool or vomit.
• This can be confirmed with a faecal
occult blood test.
• Differentiating between upper and lower
bleeding in some cases can be difficult.
imaging
• A CT angiography is useful for determining the
exact location of the bleeding within the
gastrointestinal tract.
Management
• The initial focus is on resuscitation beginning
with airway management and fluid
resuscitation using either intravenous fluids
and or blood.
• A number of medications may improve
outcomes depending on the source of the
bleeding
Management
• History taking - time of bleeding
- amount of bleeding
- number of times
- NSAID use
- alcohol ingestion
- other precipitating
cause
Examination
• Quick assessment of shock, palor
• BP
• Pulse rate
• Chronic liver disease signs
Initial supportive management/Acute
bleeding
• Insertion of access site e.g. cannula, central
lines
• Blood group, x match
• IV Fluids
• Blood transfusion
Drug management/Acute variceal bleeding
• Vasopressin
• Octreotide infusion
• Antibiotics
• Coagulation correction
Endoscopy management
• First 24 hours crucial
• Diagnostic
• Therapeutic
Therapeutic
• Band ligation
• Sclerotherapy
Specific drug therapy
• Only omeprazole of proven benefit
• Give as omeprazole infusion 80mg/hr
• Can combine both hemostasis and infusion
Lower GIT
Acute
• Diverticular disease
• Ischaemic colitis
• Infective colitis
• Neoplasia: Carcinoma , Polyps
Chronic
• Haemorrhoids
• Fissure-in-Ano
• Inflammatory bowel diseases: Crohn’s disease,
ulcerative colitis
Peptic Ulcers
• Accounts for 50% of all cases of upper GIT
bleeding
• Inflammatory process erodes into an artery
• Helicobacter pylori plays a central role in
etiology and management
Acute erosive Gastritis
• Affected predominantly in Duodenitis
• Erosions are produced by Aspirin and other
NSAID
• Also by infections e.g.: cytomegalovirus,
herpes simplex
Varices
• Develop as a result portal hypertension.
Neoplasm
• Caused by Ca stomach mainly and massive
haemorrhage is rare.
Mallory-Weiss tears
• These are linear tears at the oesophagogastric
junction
• Bleeding is usually moderate and self limiting.
Management of Lower GIT bleeding:
• This is dictated by the severity of the bleeding
and as for the upper GIT involves resuscitative
measures.
Lower GIT
• Similar assessment like for upper GIT
• Always do rectal digital examination
Investigation
• Stool examination
• Barium enema
• Proctoscopy/sigmoidoscopy
• Colonoscopy
Management
• Same support as upper GI bleeding
• Specific cause management
• Endoscopic management
• Surgical management
Large polyp for polypectomy
Conclusion
• GIT bleeding common
• Mainly presents as emergency
• History and clinical assesment vital
• Supportive measures essential
• Pharmacologic treatment useful
• Endoscopy major tool
• Surgical options in well selected cases.
• Thank you!
