General GIT Bleeding

8/8/2019 General GIT Bleeding

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Group 1

Fadzliana

Yamuna

Atirah

Siti Rohani


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GI bleeding are bleeding describes every formof hemorrhage (loss of blood) in thegastrointestinal tract, which including theesophagus, stomach, small intestine, largeintestine or colon, rectum and anus.

Blood loss from GI tract occurs in one orcombination of four ways:

Hematemesis

Melena

HematocheziaOccult bleeding


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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


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Blood streaks on the stool indicates anal

outlet bleeding

Blood mixed with stool indicates bleedingsource higher than the rectum

Blood with mucus indicates an infectious orinflammatory disease

Currant jelly-like material indicates vascularcongestion and hyperemia (intussusceptionor midgut volvulus)


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Maroon-colored stools indicatevoluminous bleeding proximal to therectosigmoid area

Melena, passage of black, sticky (tarry)stools suggests upper GI tractbleeding, but can be as distal as theright colon

Hematemesis suggests a large bleedwith possible recurrence, melena aloneindicates less voluminous bleeding


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Common

Nasophar ngealleeding

Erosi eEsophagitis

Pepti l er

astritis ( . pylori)

allory-Weiss tear Prolapsegastropathy

Less Common

Bleeding disorders

Duplication cyst

Foreign body

Tube trauma

Vascular malformation

Esophageal varices


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Common

Anal fissure

Infectious colitis

Salmonella, Shigella,Campylobacter,

C.diff

Inflammatory bowel

disease

Intussusception

Upper GI source

Less Common

Meckels diverticulum

Duplication cystHirschsprungs enterocoliti

Gangrenous intestine

Vascular malformation


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Neonates

Most ommon sesof rent neonatal Ileeds incl de acterial enteritis,milk rotein

aller ies, int ssuseption,swallowedmaternallood,anal fissures,and l mphonodular

hyperplasia.

Erosionsof theesophageal,gastric,andduodenalmucosaarealsoa frequent cause for trueneonatal

I leeding.

Somedrugsare implicated inneonatal I leeds: NSAIDs,heparin,and tolazoline,whichareused forpersistent fetal circulation.

Indomethacin,used forpatent ductusarteriosus


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Infants

GI mucosal lesions and irritations are the mostcommon causes of GI bleeding in infants andchildren. This category includes esophagitis,gastritis, duodenitis, ulcers, colonic polyps,

and anorectal disorders.

Intussusception is a frequent and importantetiology of GI bleeding in this age group

Other causes include infectious diarrhea,midgut volvulus, Meckel diverticulum,arteriovenous malformation


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Children

Duodenal ulcer, Mallory- eiss tear, andnasopharyngeal bleeding are important causes ofbleeding in older children.

Juvenile polyps also occur frequently in children ofthe age group between 2 and 8 years old (with apeak from 3-4 years) causing painless rectal

bleeding usually from polyps in the rectosigmoidregion

Helicobacter pylorihas been associated with pepticulcer disease in children. However, H pylori

infection is common and usually asymptomatic.


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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

eakness

Shortness of breath

Abdominal pain

Pale appearance


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Upper GI tract

Common signs:

Hematemesis(clear indicator)

melena

melena orhematochezia with

hemodynamic instability

Lower Gl tract

Common signs:

Hemaochezia is usualalthough an upper GIlesion may bleedrapidly that blood does

not remain in theintestine long enoughfor melena to develop


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The test used most

often to look for thecause of GI bleeding

is called endoscopy

Used to identify the

source of bleeding

A type of endoscopycalled colonoscopy

looks at the large

intestine.Our endoscope is broken, but

luckily nurse has her mobile phone

camera its quite small

Our endoscope is broken, but

luckily nurse has her mobile phone

camera its quite small


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Diagnosis is often based on direct

observation of blood in the stool. This can

be confirmed with a fecal occult blood test.


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Initial focus in any patient with a form of gastrointestinal hemorrhage

is on resuscitation, as any further intervention is precluded by thepresence 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 acidproduction 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.


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Reduction of portal pressure:

if the bleeding is thought to be due to esophagealvarices (a complication of cirrhosis of the liver),vasopressin analogues and rarely octreotide may beadministered. Rarely, a Sengstaken-Blakemore tubemay be inserted to mechanically compress varices.

Urgent endoscopy:if the bleeding cannot be managed medically an urgentesophagogastroduodenoscopy (EGD/OGD) may identifysources of bleeding. This is a high-risk procedure bestperformed under safe circumstances in the intensivecare unit or operating theatres.

Surgical intervention:

in extreme cases of bleeding, laparotomy may berequired to identify the bleeding source.


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Esophagogastroduodenoscopy (EGD/OGD)

General GIT Bleeding

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