Gastrointestinal bleeding is a disorder of digestive tract in which any organ of digestive tract bleeds. It is also termed as gastrointestinal hemorrhage. Your digestive tract consists of the following organs:
- The small intestine, including the duodenum
- large intestine or colon
These parts divide the whole digestive tract into two major parts upper GIT and lower GIT.
The esophagus, stomach, or initial part of the small intestine (duodenum), it’s considered upper GIT and the lower small intestine, large intestine, rectum, or anus are considered lower GIT.
Symptoms of this GI bleeding depends on the location of the bleeding in GIT(from mouth to anus) and the rate of bleeding. It can be mild, moderate, and severe or it can be life-threatening. Blood can come out in the form of vomit or can pass through stool (overt bleeding) or it can be occult(hidden).
The blood coming out through your digestive tract have a range from a very small amount of blood to a life-threatening hemorrhage.
Symptoms of Gastrointestinal Bleeding
GI bleeding from any site or in any form produces some clinical signs and symptoms that may warn you about your health. Symptoms depend on the type of bleeding.
Overt bleeding symptoms
It may include blood in the vomit(red or dark brown or coffee-colored), black tarry stools(in upper GI bleed), rectal bleeding(in case of lower GI bleed).
Occult bleeding symptoms
It may include lightheadedness, fainting, difficult breathing, chest, or abdominal pain.
If bleeding occurs rapidly and in large amounts, the patient can go into shock. Symptoms of shock include rapid pulse, low blood pressure, low urine output, and unconsciousness.
Classification of Gastrointestinal Bleeding
GI bleeding is broadly categorized into two major types based upon their site of bleeding
- Acute/ Chronic Upper GI bleeding
- Acute/ Chronic lower GI bleeding
1- Acute Upper Gi Bleeding
Acute upper GI bleeding may originate in the upper part of the digestive tracts such as the esophagus, stomach, and duodenum. Upper GI bleeding can be classified based upon anatomic and pathophysiologic factors: ulcerative, vascular, traumatic, iatrogenic, tumors, portal hypertension. The commonest causes of acute upper GI bleeding are peptic ulcer disease including from the use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), vasculitis, variceal hemorrhage, bleeding disorder, esophagitis, Mallory-Weiss tear, clotting disorder and neoplasms including gastric cancers.
How Patients Of Upper Gi Bleeding Presents?
Patients having Upper GI bleeding usually presents with the
- Hematemesis (vomiting of the fresh blood), * “coffee-ground” emesis (vomiting of dark brown blood),
- The presence of frank bloody emesis suggests more active and severe bleeding in comparison to the coffee-ground emesis
- And/or melena (black tarry stools). Hematochezia (passing of red blood from the rectum). It shows the bleeding from the lower gastrointestinal tract but sometimes it can be an indication for a briskly bleeding upper GI source.
Variceal hemorrhage is a life-threatening condition, therefore, it should be a major consideration while making a diagnosis.
Because it accounts for up to 30% of all cases of acute upper GI bleeding.
2- Acute Lower Gi Bleeding
Acute lower GI bleeding may originate in the lower part of digestive tracts such as small bowel, colon, or rectum. The causes of acute lower GI bleeding may also be grouped into categories based on the pathophysiology: vascular, inflammatory, neoplastic, traumatic, and iatrogenic. Common causes of lower GI bleeding are angiodysplasia or telangiectasia,
diverticular disease, neoplasms including colorectal cancer, Crohn’s disease, and ulcerative colitis, and benign anorectal lesions such as anal fissures, hemorrhoids, and rectal ulcers.
How Patients With Lower Gi Bleeding Present?
Patients having Lower GI bleeding usually present with the hematochezia, bleeding from the right colon or the small intestine can present with melena.
Bleeding from the left side of the colon tends to present bright red in color, whereas bleeding from the right side of the colon often appears dark or maroon-colored and may be mixed with stool.
Complications of Gastrointestinal Bleeding
If bleeding continues through your vomit or stool and you left it untreated, you can have some serious complications such as shock, anemia, infection, and death due to tremendous loss of blood.
Treatment of Gastrointestinal Bleeding
Treatment depends upon the exact cause of bleeding. Therefore, proper history, examination, and other investigations such as complete blood count, liver functions test, renal function test, abdominal ultrasound, barium meal, CT scan, etc should be made before starting the treatment.
The most common cause of GI bleeding is a peptic ulcer which is treated by giving the Proton pump inhibitors, antacids, avoid taking fizzy drinks and spices.
If a patient presents with gastrointestinal bleeding and cirrhosis, they need to undergo urgent endoscopy and the source of the bleed needs to be identified as soon as possible.
If the cause is esophageal varices, band ligation is the first-line treatment that should be applied. Patients who don’t respond to this treatment and have continued uncontrolled bleeding, transjugular hepatic portosystemic shunting (TIPS) therapy is a good option to them.
Treatment for esophagitis depends on its cause. Possible treatments include antibiotics, antivirals, antifungals, steroids, and endoscopy to remove any lodged pill fragments.
Therefore, the first need is to identify the actual cause of bleeding, site of bleeding, rate of bleeding, and amount of bleeding. When your physician identified the cause of your GI bleeding, after that he will start your treatment according to your need.
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