GI Bleeding

Definitions:
Upper: esophagus + stomach + duodenum
Lower: below ligament of Treitz

Hematemesis: vomit blood (fresh, red) ; upper GI + moderate-severe + maybe ongoing

Melaena: black tarry stool because of degraded hb by colon bacteria ; stomach, jejunum, ilium

Coffee ground emesis: vomiting blood that has been oxidized by the acid in the stomach so that the iron in
the blood has turned dark; upper GI + low rate

Maroon colored stools: bleeding higher in the colon or in the small bowel (right colon)

Hematochezia: blood passing through rectum (not necessarily with stool; fresh blood) ; lower GI + left colon
+ rectum + massive, brisk upper GI bleed

Upper Lower

Site esophagus + stomach + duodenum below ligament of Treitz

Causes Chronic ulcer (duodenal more common than 1. Young <50 years:

gastric)
•Anorectal
Erosive gastritis
(hemorrhoids, anal
Varices
ssure)

Mallory weiss tear

•Infectious
Esophagitis
colitis( shigella,
Cancer E.Coli)

•IBD (ulcerative
colitis)

2. Old >50 years:

•Diverticulosis

•Angiodysplasias

•Neoplasms

•Ischemic Colitis

Bledding w/pain: anal

ssure, ischemic colitis
& IBD

Painless: internal
hemorrhoids +
diverticulsis +
angiodysplasia

Clinical features Hematemesis

Hematochezia
Melena
Maroon colored stools
Co eground vomitting

Severe bleeding Symptoms Weakness + nausea + sweating +

disorientation

Signs Postural hypotension decreased by more

than 10 = >20% blood loss

Tachycardia

↓ urine (hypovolemia)

Shock
fi
fi
ff

 Investigation Endoscopy
Rectal exam (anscopy +
Angiography (if endoscopy won’t work due to sigmoidoscopy)

rapid bleeding)
Technetium-99m RBC
Radionuclide scan
scan (detect source in
Blood CP
active bleeding)

Urea, creatinine, electrolytes

Angiography (w/ active
LFT, PT bleeding)

Colonoscopy

Occult vs Overt Bleeding:

Overt OGIB refers to visible bleeding (i.e. melena or hematochezia), whereas occult OGIB refers to cases
of fecal occult blood positivity and/or unexplained iron deficiency anemia.

Occult bleeding
Definition:
Small amounts of blood in stool lost from GIT but cannot be seen
Causes:
- Tumors (esp. colon cancer)
- Peptic ulcer + esophagitis
- NSAIDs
- Angiodysplasia
- Infections (hook worm)
Investigation:
- Fecal occult blood testing
1. Guaiac Test
• Place fecal sample on guaiac paper (Guaiacum wood phenolic compound) + hydrogen
peroxidase = blue (if there’s blood)
• May require dietary restriction to avoid false positive
2. Immunichemical decal occult blood test
• More sensitive; best
3. Flushable reagent pad or tissue