Gastrointestinal bleeding
Gastrointestinal bleeding | |
---|---|
Other names | Gastrointestinal hemorrhage, GI bleed |
Prognosis | ~15% risk of death[1][7] |
Frequency | Upper: 100 per 100,000 adults per year[8] Lower: 25 per 100,000 per year[2] |
Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of
Bleeding is typically divided into two main types:
Initial treatment focuses on
An upper GI bleed is more common than lower GI bleed.[2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year.[8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year.[2] It results in about 300,000 hospital admissions a year in the United States.[1] Risk of death from a GI bleed is between 5% and 30%.[1][7] Risk of bleeding is more common in males and increases with age.[2]
Classification
Gastrointestinal bleeding can be roughly divided into two clinical syndromes: upper gastrointestinal bleeding and lower gastrointestinal bleeding.[2] About 2/3 of all GI bleeds are from upper sources and 1/3 from lower sources.[12] Common causes of gastrointestinal bleeding include infections, cancers, vascular disorders, adverse effects of medications, and blood clotting disorders.[2] Obscure gastrointestinal bleeding (OGIB) is when a source is unclear following investigation.[13]
Upper gastrointestinal
Upper gastrointestinal bleeding is from a source between the
A number of medications are found to cause upper GI bleeds.
Lower gastrointestinal
Lower gastrointestinal bleeding is typically from the colon, rectum or anus.[2] Common causes of lower gastrointestinal bleeding include hemorrhoids, cancer, angiodysplasia, ulcerative colitis, Crohn's disease, and aortoenteric fistula.[2] It may be indicated by the passage of fresh red blood rectally, especially in the absence of bloody vomiting. Lower gastrointestinal bleeding could also lead to melena if the bleeding occurs in the small intestine or proximal colon.[1]
Signs and symptoms
Gastrointestinal bleeding can range from small non-visible amounts, which are only detected by laboratory testing, to massive bleeding where bright red blood is passed and
A number of foods and medications can turn the stool either red or black in the absence of bleeding.
Diagnosis
Diagnosis is often based on direct observation of blood in the stool or vomit. Although
Clinical
Gastric aspiration and or lavage, where a tube is inserted into the stomach via the nose in an attempt to determine if there is blood in the stomach, if negative does not rule out an upper GI bleed[18] but if positive is useful for ruling one in.[12] Clots in the stool indicate a lower GI source while melana stools an upper one.[12]
Laboratory testing
Recommended laboratory blood testing includes: cross-matching blood, hemoglobin, hematocrit, platelets, coagulation time, and electrolytes.[4] If the ratio of blood urea nitrogen to creatinine is greater than 30 the source is more likely from the upper GI tract.[12]
Imaging
A
Prevention
In patients with significant varices or cirrhosis
Among patients admitted to the ICU with high risk of bleeding, a PPI or H2RA appears useful.[22][23]
Treatment
The initial focus is on resuscitation beginning with airway management and fluid resuscitation using either intravenous fluids and or blood.[4] A number of medications may improve outcomes depending on the source of the bleeding.[4]
Peptic ulcers
Based on evidence from people with other health problems
Variceal bleeding
For initial fluid replacement, colloids or
Blood products
The evidence for benefit of blood transfusions in GI bleed is poor with some evidence finding harm.
If the INR is greater than 1.5 to 1.8 correction with fresh frozen plasma or
Procedures
The benefits versus risks of placing a
Colonoscopy is useful for the diagnosis and treatment of lower GI bleeding.[2] A number of techniques may be employed including clipping, cauterizing, and sclerotherapy.[2] Preparation for colonoscopy takes a minimum of six hours which in those bleeding briskly may limit its applicability.[36] Surgery, while rarely used to treat upper GI bleeds, is still commonly used to manage lower GI bleeds by cutting out the part of the intestines that is causing the problem.[2] Angiographic embolization may be used for both upper and lower GI bleeds.[2] Transjugular intrahepatic portosystemic shunting (TIPS) may also be considered.[14]
Prognosis
Death in those with a GI bleed is more commonly due to other illnesses (some of which may have contributed to the bleed, such as cancer or cirrhosis) than the bleeding itself.
Epidemiology
Gastrointestinal bleeding from the upper tract occurs in 50 to 150 per 100,000 adults per year.[8] It is more common than lower gastrointestinal bleeding which is estimated to occur at the rate of 20 to 30 per 100,000 per year.[2] Risk of bleeding is more common in males and increases with age.[2]
References
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- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad Westhoff, John (March 2004). "Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification". Emergency Medicine Practice. 6 (3). Archived from the original on 2013-07-22. Retrieved 2012-04-20.
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- ^ a b "Bleeding in the Digestive Tract". The National Institute of Diabetes and Digestive and Kidney Diseases. September 17, 2014. Archived from the original on 21 February 2015. Retrieved 6 March 2015.
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- ^ "Management of acute lower GI bleeding". University of Pennsylvania Health System (UPHS). Jan 2009. p. 6. Archived from the original on 2013-02-20. Retrieved 2012-04-23.
External links
- "Gastrointestinal Bleeding". MedlinePlus. U.S. National Library of Medicine.