ACUTE GI BLEEDING

Gastrointestinal Bleeding = refers to any bleeding that starts in the gastrointestinal tract
Bleeding may come from any site along the GI tract, but is often divided into:
o UPPER GI bleeding
o LOWER GI bleeding
Causes/Etiology: may be due to conditions including:
Upper GI tract disorders:
o Peptic Ulcer Disease
- Duodenal ulcer
- Gastric ulcer
o Gastric or duodenal erosions
o Gastroesophageal Varices

Lower GI tract disorders:

o Anal fissures
o Colitis: Radiation, ischemic, infectious
o Colonic sarcoma
o Colonic polyps
o Diverticular disease
o IBD (Ulcerative Colitis, Crohn’s disease)
o Internal hemorrhoids

Clinical Manifestation:
 Hematemesis
 Melena
 Hematochezia
 Syncope
 Dyspepsia (indigestion)
 Epigastric pain
 Heartburn
 Diffuse abdominal pain
 Dysphagia
 Weight loss
 Signs of shock: HYPOTENSION, DECREASED PULSES, DECREASED URINE OUTPUT
 Jaundice
Risk Factors:
 Chronic Vomiting
 Alcoholism
 Medications
 Gastrointestinal surgery
Diagnostic and Laboratory Procedures:
 ENDOSCOPY
 EGD
 Colonoscopy
 Radiographic procedures
 Serum blood studies
MANAGEMENT/TREATMENT:
- FLUID resuscitation
- Hemostasis
- Airway
- Active variceal bleeding
- General Support
Medical Management:
 Antacids: Calcium Carbonate
 Histamine Blockers: Cimtidine, Ranitidine, Famotidine
 Cytoprotective agents: Sucralfate
 Proton-pump inhibitors (PPI): Omeprazole, esomeprazole, Lansoprazole
 IV medication: Pantoprazole
 Mucosal barrier enhancer: Colloidal bismuth, prostaglandins
Nursing Management:
All critically ill patients should be considered at risk for stress ulcers and therefore GI hemorrhage.
Maintaining GASTRIC fluid pH 3.5-4.5 is a goal of prophylactic therapy
o Major nursing interventions are:
 Administering volume replacement
 Controlling bleeding
 Maintaining surveillance for complications (i.e. hemorrhagic shock)
 Educating family and patient