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Gastrointestinal bleeding: Difference between revisions

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Created page with "'''Gastrointestinal (GI) bleeding''' can range from occult (no symptoms, only found on occult blood test) to severe and life-threatening. It may manifest as haematemesis, haemodynamic instability, melena, or haematochezia. '''Haematemesis''' refers to vomiting of fresh blood, clotted blood, or coffee grounds-like material. '''Haematochezia''' refers to fresh or clotted blood per rectum and is typically a sign of lower GI tract bleeding, while '''melena''' refers to pass..."
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Gastrointestinal bleeding can be '''occult''', meaning that blood is present in the stool but not visible to the naked eye. Occult, chronic, or intermittent GI bleeding can be a sign of gastrointestinal cancer.
Gastrointestinal bleeding can be '''occult''', meaning that blood is present in the stool but not visible to the naked eye. Occult, chronic, or intermittent GI bleeding can be a sign of gastrointestinal cancer.
[[Variceal bleeding]] has a higher mortality than '''non-variceal upper GI bleeding''', but the latter also has a high mortality rate, up to 15%. 70% of cases stop bleeding spontaneously, while the remaining either rebleed in 1 – 3 days or continuously bleed. These bleedings most frequently originate from ulcers.


== Etiology ==
== Etiology ==
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Melena:
Melena:


* [[Peptic ulcer disease|Peptic ulcer]]
* Peptic ulcer
* [[Oesophagitis]]
* Oesophagitis
* [[Gastritis]]
* Gastritis
* [[Oesophageal varix|Oesophageal varices]]
* Oesophageal varices
* Angiodysplasia
* Angiodysplasia


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* [[Colorectal carcinoma|Colorectal cancer]]
* [[Colorectal carcinoma|Colorectal cancer]]
* Angiodysplasia
* Angiodysplasia
The most important risk factors for ulcer bleeding are:
* NSAID and aspirin use
* H. pylori infection
* Alcohol
* Anticoagulants and antiplatelets


== Clinical features ==
== Clinical features ==
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== Treatment ==
== Treatment ==
In case of acute bleeding, urgent assessment and stabilisation are crucial. If the patient is haemodynamically unstable they must be stabilised first. This involves monitoring, replacing lost fluids, and blood transfusion. Blood transfusion is indicated at haemoglobin level < 70 g/L, with a target of 70 – 90 g/L. Intubation may be necessary to protect the airway.
In case of acute bleeding, urgent assessment and stabilisation are crucial. If the patient is haemodynamically unstable they must be stabilised first. This involves monitoring, replacing lost fluids, and blood transfusion. Blood transfusion is indicated at haemoglobin level < 70 g/L, with a target of 70 – 90 g/L.
 
Then, we should determine the source of the bleeding, stop it, treat the underlying condition, and prevent recurrent bleeding. This may include [[terlipressin]] for [[Variceal bleeding|varices]].
 
Upper endoscopy is the main tool in the evaluation of acute upper GI bleeding, as it allows for both diagnosis and treatment of the underlying cause. It should be performed as soon as possible when the patient is haemodynamically stable. Administering erythromycin prior to endoscopy is useful, as its prokinetic properties help remove residual blood and gastric content.
 
If there is active bleeding, a non-bleeding visible vessel, or an adherent clot to the ulcer, endoscopic therapy with IV PPI is indicated. If there is a flat spot or clean based ulcer, no endoscopic therapy is necessary, only oral PPI. Endoscopic haemostasis may be achieved with:
 
* Electrocoagulation
* Heat
* Laser
* Clipping
* Banding
* Injection of adrenaline, sclerosing agents, or fibrin glue
 
=== Surgical treatment ===
Surgical therapy is indicated if endoscopic therapy fails, if the ulcer is large (> 2 cm), if there is perforation, or if the bleeding is so large that the patient requires many units of blood (4 – 6). However, > 90% of gastrointestinal bleedings are managed without surgery.
 
Surgical options depend on the underlying cause and include:


* Bleeding ulcer
Then, we should determine the source of the bleeding, stop it, treat the underlying condition, and prevent recurrent bleeding. This involves upper endoscopy.
** Oversewing the ulcer
** Vagotomy
** Pyloroplasty
* Perforation
** Bowel resection
* Lower <abbr>GI</abbr> bleeding
** Segmental colectomy/hemicolectomy
<noinclude>
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Gastrointestinal surgery]]‎[[Category:Internal Medicine (POTE course)]]</noinclude>