Gastrointestinal bleeding

Bleeding from any part of gastrointestinal tract form mouth to anus is defined as gastrointestinal bleeding, Patient may be having bleeding from the mouth (fresh red or coffee colored altered blood) or in the stool. (which can be red, maroon, black).

Common causes of GI bleed are
Upper GI bleed

Esophageal source

  • Mallory Weiss tear
  • Esophageal varices
  • Esophagitis
  • Esophageal ulcer
  • Esophgageal cancer
  • Hiatus hernia with Cameron ulcers

Gastric source

  • Gastric ulcer
  • Gastric cancer
  • Gastric varix
  • Gastritis or gastropathy
  • Dieulafouy’s lesion
  • Gastric antral vascular ectasia

Duodenal source

  • Duodenal ulcer
  • Duodenal tumor

Lower GI bleed

Anal canal sources (Bright red blood)

  • Hemorrhoids
  • Fissure

Colonic source

  • Colonic ulcer- Infective or Inflammatory bowel disease
  • Colonic polyp or cancer
  • Angiodysplasia
  • Diverticular bleed

Small intestinal source

  • Angiodysplasias
  • Telengectasias
  • Tumor of small intestine
  • Meckel’s diverticulum
  • Ulcerations of small intestine

Management of GI bleed depends upon magnitude and source of bleed, patients with significant bleed should be admitted and resuscitated with blood and plasma expander infusion. Patient with chronic and small amount of bleed can be investigated as out patient. Upper GI endoscopy and colonoscopy are the initial investigations for the cause of bleed, if these investigations are normal, next line of investigations are CT enterography and CT angiography, capsule endoscopy and double balloon enteroscopy.

Once the cause is established treatment depends upon cause of bleed and includes ligation for esophageal varices, clip and APC application for ulcers and vascular lesions, and surgery for malignancies

 

Variceal band ligation Clip application for ulcer Glue application for fundal varix

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