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Gastrointestinal bleeding
 
 
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Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage (loss of blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
) in the gastrointestinal tract
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
, from the pharynx
Pharynx

FunctionsThe pharynx is part of the digestive system and respiratory system of many organisms.Because both food and Earth's atmosphere pass through the pharynx, a flap of connective tissue called the epiglottis closes over the trachea when food is swallowed to prevent choking or Pulmonary aspiration....
 to the rectum
Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the Gastrointestinal tract in others, terminating in the anus....
. It has diverse causes, and a medical history, as well as physical examination
Physical examination

File:Reeve 978.jpgPhysical examination or clinical examination is the process by which a health care provider investigates the body of a patient for sign of disease....
, generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding.

Initial emphasis is on resuscitation by infusion of intravenous fluids
Intravenous therapy

File:Infuuszakjes.jpgIntravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip....
 and blood transfusion
Blood transfusion

Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to Physical trauma, or can be used to replace blood lost during surgery....
, treatment with proton pump inhibitor
Proton pump inhibitor

Proton pump inhibitors are a group of Medications whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today....
s and occasionally with vasopressin
Vasopressin

Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a hormone found in most mammals, including humans....
 analogues and tranexamic acid
Tranexamic acid

Tranexamic acid is often prescribed for excessive bleeding. It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, a molecule responsible for the degradation of fibrin....
.






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Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage (loss of blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
) in the gastrointestinal tract
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
, from the pharynx
Pharynx

FunctionsThe pharynx is part of the digestive system and respiratory system of many organisms.Because both food and Earth's atmosphere pass through the pharynx, a flap of connective tissue called the epiglottis closes over the trachea when food is swallowed to prevent choking or Pulmonary aspiration....
 to the rectum
Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the Gastrointestinal tract in others, terminating in the anus....
. It has diverse causes, and a medical history, as well as physical examination
Physical examination

File:Reeve 978.jpgPhysical examination or clinical examination is the process by which a health care provider investigates the body of a patient for sign of disease....
, generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding.

Initial emphasis is on resuscitation by infusion of intravenous fluids
Intravenous therapy

File:Infuuszakjes.jpgIntravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip....
 and blood transfusion
Blood transfusion

Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to Physical trauma, or can be used to replace blood lost during surgery....
, treatment with proton pump inhibitor
Proton pump inhibitor

Proton pump inhibitors are a group of Medications whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today....
s and occasionally with vasopressin
Vasopressin

Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a hormone found in most mammals, including humans....
 analogues and tranexamic acid
Tranexamic acid

Tranexamic acid is often prescribed for excessive bleeding. It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, a molecule responsible for the degradation of fibrin....
. Upper endoscopy or colonoscopy
Colonoscopy

Colonoscopy is the endoscopy examination of the large Colon and the distal part of the ileum with a CCD camera or a fiber optic camera on a flexible tube passed through the anus....
 are generally considered appropriate to identify the source of bleeding and carry out therapeutic interventions.

Symptoms and signs

Gastrointestinal bleeding can range from microscopic bleeding, where the amount of blood is so small that it can only be detected by laboratory testing (in the form of iron deficiency anemia
Iron deficiency anemia

For a discussion of iron deficiency more broadly, see the Wikipedia article iron deficiency .Iron deficiency anemia is the most common type of anemia, and is also known as sideropenic anemia. It is the most common cause of microcytic anemia....
), to massive bleeding where pure blood is passed and hypovolemia
Hypovolemia

In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
 and shock may develop, risking death
Death

Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....
.

Classification

Gastrointestinal bleeding can be roughly divided into two clinical syndromes.

Upper gastrointestinal bleeding

Upper gastrointestinal bleeding is from a source between the pharynx
Pharynx

FunctionsThe pharynx is part of the digestive system and respiratory system of many organisms.Because both food and Earth's atmosphere pass through the pharynx, a flap of connective tissue called the epiglottis closes over the trachea when food is swallowed to prevent choking or Pulmonary aspiration....
 and the ligament of Treitz
Suspensory muscle of the duodenum

The suspensory muscle of the duodenum is the proper name of what is commonly known as the ligament of Treitz , and it refers to tissue that connects the duodenum of the small intestines to the diaphragm ....
. An upper source is characterised by hematemesis
Hematemesis

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the former is more common....
 (vomiting up blood) and melena
Melena

In medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon ....
 (tarry stool containing altered blood).

Lower gastrointestinal bleeding

Lower gastrointestinal bleeding may be indicated by red blood per rectum, especially in the absence of hematemesis
Hematemesis

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the former is more common....
. Isolated melena may originate from anywhere between the stomach and the proximal colon.

Treatment


Early management

Initial focus in any patient with a form of gastrointestinal hemorrhage is on resuscitation, as any further intervention is precluded by the presence of intravascular depletion or shock.
  • Fluid resuscitation: intravenous fluids and blood transfusion
    Blood transfusion

    Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to Physical trauma, or can be used to replace blood lost during surgery....
     may be administered.
  • Acid suppression: in an upper GI source, proton pump inhibitor
    Proton pump inhibitor

    Proton pump inhibitors are a group of Medications whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today....
    s reduce gastric acid
    Gastric acid

    Gastric acid is one of the main secretions of the stomach, together with several enzymes and intrinsic factor. Chemically it is an acid solution with a pH of 1 to 2 in the stomach lumen , consisting mainly of hydrochloric acid , and large quantities of potassium chloride and sodium chloride ....
     production and enhance healing of bleeding lesions.
  • Inhibition of fibrinolysis: in ongoing bleeding, tranexamic acid
    Tranexamic acid

    Tranexamic acid is often prescribed for excessive bleeding. It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, a molecule responsible for the degradation of fibrin....
     reduces fibrinolysis
    Fibrinolysis

    Fibrinolysis is the process wherein a fibrin thrombus, the product of coagulation, is broken down. Its main enzyme plasmin cuts the fibrin mesh at various places, leading to the production of circulating fragments that are cleared by other proteases or by the kidney and liver....
     and may decrease blood product requirements.
  • Correction of coagulopathy: if coagulation
    Coagulation

    Coagulation is a complex process by which blood forms clots. It is an important part of hemostasis , wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop hemorrhage and begin repair of the damaged vessel....
     parameters (e.g. prothrombin time
    Prothrombin time

    The prothrombin time and its derived measures of prothrombin ratio and international normalized ratio are measures of the extrinsic pathway of coagulation....
    ) are deranged, vitamin K
    Vitamin K

    Vitamin K denotes a group of lipophilic, hydrophobic vitamins that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation....
     or fresh frozen plasma
    Fresh frozen plasma

    Fresh Frozen Plasma is defined as the fluid portion of one unit of human blood that has been centrifuged, separated, and frozen solid at within 6 hours of collection....
     may need to be administered.
  • Reduction of portal pressure: if the bleeding is thought to be due to esophageal varices
    Esophageal varices

    In medicine , esophageal varices are extremely dilation sub-mucosal veins in the esophagus. They are most often a consequence of portal hypertension, such as may be seen with cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding....
     (a complication of cirrhosis
    Cirrhosis

    Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver Tissue by fibrous scar tissue as well as regenerative Nodule , leading to progressive loss of liver function....
     of the liver), vasopressin
    Vasopressin

    Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a hormone found in most mammals, including humans....
     analogues and rarely octreotide
    Octreotide

    Octreotide is an peptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone....
     may be administered. Rarely, a Sengstaken-Blakemore tube
    Sengstaken-Blakemore tube

    A Sengstaken-Blakemore tube is an oro- or nasogastric tube used occasionally in the management of upper gastrointestinal hemorrhage due to bleeding from esophageal varices ....
     may be inserted to mechanically compress varices.
  • Urgent endoscopy: if the bleeding cannot be managed medically an urgent esophagogastroduodenoscopy
    Esophagogastroduodenoscopy

    In medicine , esophagogastroduodenoscopy is a diagnosis endoscopy procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum....
     (EGD/OGD) may identify sources of bleeding. This is a high-risk procedure best performed under safe circumstances in the intensive care unit
    Intensive Care Unit

    An intensive care unit , critical care unit , intensive therapy unit or intensive treatment unit is a specialized department used in many countries' hospitals that provides intensive care medicine....
     or operating theatre
    Operating theatre

    An operating theater was a tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery. Today the term is sometimes used synonymously with operating room or operating suite, the room within a hospital where surgical operations are carried out today....
    s.
  • Surgical intervention: in extreme cases of bleeding, laparotomy
    Laparotomy

    A laparotomy is a surgery procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy....
     may be required to identify the bleeding source.


Endoscopy

After adequate stabilization, endoscopy
Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope....
 (upper endoscopy and/or colonoscopy
Colonoscopy

Colonoscopy is the endoscopy examination of the large Colon and the distal part of the ileum with a CCD camera or a fiber optic camera on a flexible tube passed through the anus....
) are used to identify the source of bleeding. Injection, sclerotherapy, electrocoagulation, vascular clipping
Endoclip

An endoclip is a metallic mechanical device used in endoscopy in order to close two mucosal surfaces without the need for surgery and surgical suture....
 and biopsy may be performed.

Endoscopy is also useful in setting the indication for therapy, e.g. the need for long-term proton pump inhibitor
Proton pump inhibitor

Proton pump inhibitors are a group of Medications whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today....
 therapy, presence of esophageal varices
Esophageal varices

In medicine , esophageal varices are extremely dilation sub-mucosal veins in the esophagus. They are most often a consequence of portal hypertension, such as may be seen with cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding....
, adenomatous polyps and so on.