Gastrointestinal Bleeding

Introduction

Gastrointestinal (GI) bleeding is a common clinical problem in the US Recent mortality rates from upper GI hemorrhage vary from 3.5% to 7% in the US Most patients stop bleeding spontaneously Early and accurate diagnosis of patients with severe bleeding can facilitate therapeutic maneuvers, leading to lower mortality rates

Clinical Presentation

To determine the urgency of the situation

Agitation, pallor, hypotension, and tachycardia may indicate shock requiring immediate volume replacement. Shock occurs when blood loss approaches 40% of the total blood volume Postural hypotension of 10 mm Hg or higher usually indicates at least a 20% reduction in blood volume

Resuscitation Location of bleeding

Table Prognostic Value Of The Severity Of Upper Gastrointestinal Bleeding

NASOGASTRIC ASPIRATE Clear Coffee grounds Red blood MORTALITY RATE (%) 10 10 20 10 20 30

STOOL COLOR Red, brown, black Brown or black Red Black Brown Red

Adapted from Silverstein FE, Gilbert DA, Tedeseo FJ. The National ASGE Survey, on upper gastrointestinal bleeding Gastrointest Endosc 1981;27:73.

Cause Gatrointestinal Bleeding

Peptic ulcer bleeding Hemorrhage from gastric erosion Esophageal varices Gasric varices Mallory Weiss tear Esophagitis and esophageal ulcer Erosive duodenitis Neoplasms Angiodysplasia

Diagnostic Approach

History and phisical examination

the recent use of NSAID alcohol history of cirrhosis stigmata of cirrhosis malignancy abdominal tenderness hepatic or splenic enlargement

Endoscopy Radionuclide scan Angiography

Treatment

Empiric and specific. Specific treatments depend on the diagnosis and the presence or absence of continued bleeding Empiric treatment is often initiated before diagnostic examinations Patients who continue to bleed for more than 24 hours, require more than a 6- to 8-unit transfusion,