Gastrointestinal bleeding

· · Introduction :

Gastrointestinal bleeding describes every form of haemorrhage in the gastrointestinal tract starting from the pharynx to the rectum.

GIT bleeding ranges from microscopic bleeding to massive bleeding according to its cause.

GIT bleeding is categorized into upper GIT bleeding and lower GIT bleeding according to the site of bleeding.

Upper GIT bleeding:-

• Definition: This is any bleeding in the gastrointestinal tract above the level of ligament of Treitz.

• Causes : 1- Varices “as oesophageal varices”

2- Ulceration “as peptic ulcer”

3- Inflammation “as gastritis”

4- Tumour “benign as polyp, malignant as carcinoma”

5- Vascular malformation

• Presentation: the patient may be presented with local clinical picture as hematemesis or melena or general clinical picture for Haemorrhage as tachycardia with low blood pressure or anemia.

Lower GIT bleeding:-

• Definition: This is any bleeding in the gastrointestinal tract below the level of ligament of Treitz.

• Causes : 1- Coagulopathy

2- Inflammation “as colitis”

3- Haemorrhoids

4- Vascular malformation

5- Tumour “benign as polyp, malignant as carcinoma”

• Presentation: the patient may be presented with local clinical picture as bleeding per rectum or hematochezia or general clinical picture for haemorrhage as tachycardia with low blood pressure or anemia.

Diagnosis:-

• 1- Taking proper history

• 2- General and local examinations

• 3- Laboratory tests for haemoglobin , hematocrit value, platelets

• 4- Aspiration from the stomach

• 5- Diagnostic Endoscope

• 6- Digital rectal exam

Management:-

1- Management of bleeding

• Monitoring vital signs

• Maintaining IV set

• Reduction of portal pressure