Gastrointestinal bleeding
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| Gastrointestinal bleeding Classification and external resources | |
| ICD-10 | K92.2 |
|---|---|
| ICD-9 | 578.9 |
| DiseasesDB | 19317 |
| MedlinePlus | 003133 |
| eMedicine | radio/301 radio/302 emerg/381 |
| MeSH | D006471 |
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Overview
Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage (loss of blood) in the gastrointestinal tract, from the pharynx to the rectum. It has diverse causes, and a medical history, as well as physical examination, generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding.
Initial emphasis is on resuscitation by infusion of intravenous fluids and blood transfusion, treatment with proton pump inhibitors and occasionally with vasopressin analogues and tranexamic acid. Upper endoscopy or colonoscopy are generally considered appropriate to identify the source of bleeding and carry out therapeutic interventions.
- Hematemesis is defined as vomiting blood (fresh blood, clots or "coffee grounds") and is usally due to a bleed in the upper GI tract
- Melena refers to black, tarry stools and signals an upper GI bleed (blood has had time to be
- Hematochezia refers to red, bloody stools and signals a lower GI bleed or brisk bleeding in the upper GI tract
Symptoms and signs
Gastrointestinal bleeding can range from microscopic bleeding, where the amount of blood is so small that it can only be detected by laboratory testing (in the form of iron deficiency anemia), to massive bleeding where pure blood is passed and hypovolemia and shock may develop, risking death.
Classification
Gastrointestinal bleeding can be roughly divided into two clinical syndromes.
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding is from a source between the pharynx and the ligament of Treitz. An upper source is characterised by hematemesis (vomiting up blood) and melena (tarry stool containing altered blood).
Lower gastrointestinal bleeding
Lower gastrointestinal bleeding may be indicated by red blood per rectum, especially in the absence of hematemesis. Isolated melena may originate from anywhere between the stomach and the proximal colon.
Differential Diagnosis
Main Causes
- Diverticula
- Hemorrhoid bleeding
- Inflammatory colonic diseases
- Ischemic colonic diseases
- Tumors or polyps
- Ulcerative diseases
Upper GI Bleeding
- Angiodysplasia
- Anticoagulant therapy
- Arteriovenous malformation
- Carcinoid tumor
- Coagulopathy
- Connective Tissue Disease
- Cytomegalovirus (CMV)
- Duodenal ulcer
- Duodenal varices
- Duodenum erosion
- Epistaxis
- Esophageal carcinoma
- Esophageal ulcer
- Esophageal varices
- Gastric ulcer
- Gastric carcinoma
- Gastric varices
- GI foreign bodies
- Helicobacter pylori
- Hemolytic Uremic Syndrome
- Henoch-Schonlein Purpura
- Hereditary Hemorrhagic Telangiectasia
- Herpes
- Ischemic Enteritis
- Karposi's Sarcoma
- Leukemia
- Lower esophagus erosion
- Lymphoma
- Mallory-Weiss Tear
- Metestatic tumor
- Osler's Disease
- Polyarteritis Nodosa
- Rheumatoid Arteritis
- Rheumatoid vasculitis
- Small bowel carcinoma
- Stomach erosion
- Stomal ulcer
- Systemic Lupus Erythematosus
- Upper GI polyp
- Uremia
- Volvulus
Lower GI Bleeding
- Amoeba
- Anal fissure
- Angiodysplasia
- Angioma
- Anorectal injuries
- Aortoenteric Fistula
- Behcet's Syndrome
- Biopsy (secondary bleeding)
- Campylobacter
- Carcinoid tumors
- Carcinoma
- Colitis
- Colon polyps
- Colorectal carcinoma
- Crohn's Disease
- Diverticulosis
- Familial adenomatous polyposis
- Fissures
- Foreign body
- Gardner's Syndrome
- Hemorrhoidal sclerotherapy or ligature
- Hemorrhoids
- Inflammatory Bowel Disease
- Invagination
- Ischemic colitis
- Juvenile Polyposis
- Lymphomas
- Mechanical causes
- Meckel's Diverticulum
- Mesenteric Infarction
- Peutz-Jegher's Syndrome
- Polypectomy (secondary bleeding)
- Polyps
- Postoperative stitching
- Proctitis
- Prolapse of the rectum
- Pseudomembranous Colitis]]
- Radiation proctitis
- Radiation colitis
- Rectal ulcers
- Salmonella
- Shigella
- Small bowel tumor
- Strangulation
- Telangiectasia
- Trauma
- Ulcerative colitis
- Upper GI bleed
- Varices
- Vascular lesions
- Vasculitis
- Vibrio [1] [1]
Treatment
Early management
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.
Endoscopy
After adequate stabilization, endoscopy (upper endoscopy and/or colonoscopy) are used to identify the source of bleeding. Injection, sclerotherapy, electrocoagulation, vascular clipping and biopsy may be performed.
Endoscopy is also useful in setting the indication for therapy, e.g. the need for long-term proton pump inhibitor therapy, presence of esophageal varices, adenomatous polyps and so on.
References
- Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J 2002;78:4-14. PMID 11796865.
WikiDoc Research Resources for Gastrointestinal bleeding (Click show to right to view) | |
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| Articles on Gastrointestinal bleeding | Most recent articles on Gastrointestinal bleeding • Most cited articles on Gastrointestinal bleeding • Review articles on Gastrointestinal bleeding • Articles on Gastrointestinal bleeding in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Gastrointestinal bleeding | Powerpoint slides on Gastrointestinal bleeding • Images of Gastrointestinal bleeding • Photos of Gastrointestinal bleeding • Podcasts & MP3s on Gastrointestinal bleeding • Videos on Gastrointestinal bleeding |
| Evidence Based Medicine Regarding Gastrointestinal bleeding | Cochrane Collaboration on Gastrointestinal bleeding • Bandolier on Gastrointestinal bleeding • TRIP on Gastrointestinal bleeding |
| Cost Effectiveness of Gastrointestinal bleeding | Cost Effectiveness of Gastrointestinal bleeding |
| Clinical Trials Involving Gastrointestinal bleeding | Ongoing Trials on Gastrointestinal bleeding at Clinical Trials.gov • Trial results on Gastrointestinal bleeding • Clinical Trials on Gastrointestinal bleeding at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Gastrointestinal bleeding | US National Guidelines Clearinghouse on Gastrointestinal bleeding • NICE Guidance on Gastrointestinal bleeding • NHS PRODIGY Guidance • FDA on Gastrointestinal bleeding • CDC on Gastrointestinal bleeding |
| Textbook Information on Gastrointestinal bleeding | Books and Textbook Information on Gastrointestinal bleeding |
| Pharmacology Resources on Gastrointestinal bleeding | Dosing of Gastrointestinal bleeding • Drug interactions with Gastrointestinal bleeding • Side effects of Gastrointestinal bleeding • Allergic reactions to Gastrointestinal bleeding • Overdose information on Gastrointestinal bleeding • Carcinogenicity information on Gastrointestinal bleeding • Gastrointestinal bleeding in pregnancy • Pharmacokinetics of Gastrointestinal bleeding • |
| Genetics, Pharmacogenomics, and Proteinomics of Gastrointestinal bleeding | Genetics of Gastrointestinal bleeding • Pharmacogenomics of Gastrointestinal bleeding • Proteomics of Gastrointestinal bleeding |
| Newstories on Gastrointestinal bleeding | Gastrointestinal bleeding in the news • Be alerted to news on Gastrointestinal bleeding • News trends on Gastrointestinal bleeding |
| Commentary on Gastrointestinal bleeding | Blogs on Gastrointestinal bleeding |
| Patient Resources on Gastrointestinal bleeding | Patient resources on Gastrointestinal bleeding • Discussion groups on Gastrointestinal bleeding • Patient Handouts on Gastrointestinal bleeding • Directions to Hospitals Treating Gastrointestinal bleeding • Risk calculators and risk factors for Gastrointestinal bleeding |
| Healthcare Provider Resources on Gastrointestinal bleeding | Symptoms of Gastrointestinal bleeding • Causes & Risk Factors for Gastrointestinal bleeding • Diagnostic studies for Gastrointestinal bleeding • Treatment of Gastrointestinal bleeding |
| Continuing Medical Education (CME) Programs on Gastrointestinal bleeding | CME Programs on Gastrointestinal bleeding |
| International Resources on Gastrointestinal bleeding | Gastrointestinal bleeding en Espanol • Gastrointestinal bleeding en Francais |
| Business Resources on Gastrointestinal bleeding | Gastrointestinal bleeding in the Marketplace • Patents on Gastrointestinal bleeding |
| Informatics Resources on Gastrointestinal bleeding | List of terms related to Gastrointestinal bleeding |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
