Gastrointestinal Bleeding: Causes, Symptoms, and
Diagnosis
Types of upper gastrointestinal bleeding
1/ obvious bleeding: hematemesis, melena
2/ occult bleeding
What is the difference btw hematemesis and melena?
Hematemesis: bloody vomitus
- fresh, bright red blood
- coffee ground appearance (dark, grainy digested food) means blood has been in contact with gastric
HCl acid secretion
Melena: stools
- black, tarry stools, often foul smelling
- caused by digestion of blood in GI tract, breakdown of hemoglobin and presence of iron makes stool
black color
Occult bleeding
small amounts of blood discovered by guaiac test, appear in gastric secretions, vomitus or stools, not
easy to see
Massive upper GI hemorrhage
lost of more than 1500mL of blood or loss of 25% of intravascular blood volume
Clinically important bleeding
- decrease of more than 20mm Hg in SBP
- decrease of more than 10 mm in SBP with pt sitting up
- increase of more than 20 beats/min in the heart rate
- decrease in hemoglobin level of more than 2g/dl
Emergency treatment for upper GI bleeding
- identify the cause
- treatment initiated immediately
- DO NOT ask about what causes of the bleeding until emergency care has been initiated
1/ Physical examination: BP, Pulse (rate and character), capillary refill (peripheral perfusion), neck vein
distention (presence or absence), signs and symptoms of shock, respiratory status, abdominal
examination (bowel sounds, tense, rigid, boardlike abdoment indicate a perforation and peritonitis)
2/ Monitoring: vital signs q15-30 mins
3/ Interviewing pt or caregiver:
- previous bleeding episodes?
- recent weight loss?
- past blood transfusions? any reactions?
- other illnesses (liver disease, cirrhosis)?
, Gastrointestinal Bleeding: Causes, Symptoms, and
Diagnosis
- medication causing bleeding?
- religious preference about blood transfusion?
GI perforation
a hole on the wall of the stomach, small intestine, large bowel, rectum, or gallbladder.
GI peritonitis
inflammation of the peritoneum (lining) of the GI organ
Lab studies for upper GI bleeding
1. CBC
2. BUN
3. serum electrolytes
4. blood glucose
5. PTT
6. liver enzymes
7. ABGs
8. Type and crossmatch for blood transfusion
9. test vomitus and stools for gross and occult blood
10. Urinalysis: specific gravity to check hydration status
Drugs that cause bleeding
aspirin
NSAIDs
corticosteroids
anticoagulants
How to prepare for blood transfusion
- IV lines, referably 2
- 16- or 18- gauge needle are placed for fluid and blood replacement
- oxygen supplement: face mask or nasal cannula to help increase blood oxygen saturation
Complications of blood transfusion
- fluid overload
- immunologic reactions => packed RBCs are preferred over whole blood
What is the first thing you have to do when a pt admitted with upper GI bleeding?
a thorough and accurate nursing assessment, physical needs must be met first!
What are included in the assessment for pt with upper GI bleeding?
Diagnosis
Types of upper gastrointestinal bleeding
1/ obvious bleeding: hematemesis, melena
2/ occult bleeding
What is the difference btw hematemesis and melena?
Hematemesis: bloody vomitus
- fresh, bright red blood
- coffee ground appearance (dark, grainy digested food) means blood has been in contact with gastric
HCl acid secretion
Melena: stools
- black, tarry stools, often foul smelling
- caused by digestion of blood in GI tract, breakdown of hemoglobin and presence of iron makes stool
black color
Occult bleeding
small amounts of blood discovered by guaiac test, appear in gastric secretions, vomitus or stools, not
easy to see
Massive upper GI hemorrhage
lost of more than 1500mL of blood or loss of 25% of intravascular blood volume
Clinically important bleeding
- decrease of more than 20mm Hg in SBP
- decrease of more than 10 mm in SBP with pt sitting up
- increase of more than 20 beats/min in the heart rate
- decrease in hemoglobin level of more than 2g/dl
Emergency treatment for upper GI bleeding
- identify the cause
- treatment initiated immediately
- DO NOT ask about what causes of the bleeding until emergency care has been initiated
1/ Physical examination: BP, Pulse (rate and character), capillary refill (peripheral perfusion), neck vein
distention (presence or absence), signs and symptoms of shock, respiratory status, abdominal
examination (bowel sounds, tense, rigid, boardlike abdoment indicate a perforation and peritonitis)
2/ Monitoring: vital signs q15-30 mins
3/ Interviewing pt or caregiver:
- previous bleeding episodes?
- recent weight loss?
- past blood transfusions? any reactions?
- other illnesses (liver disease, cirrhosis)?
, Gastrointestinal Bleeding: Causes, Symptoms, and
Diagnosis
- medication causing bleeding?
- religious preference about blood transfusion?
GI perforation
a hole on the wall of the stomach, small intestine, large bowel, rectum, or gallbladder.
GI peritonitis
inflammation of the peritoneum (lining) of the GI organ
Lab studies for upper GI bleeding
1. CBC
2. BUN
3. serum electrolytes
4. blood glucose
5. PTT
6. liver enzymes
7. ABGs
8. Type and crossmatch for blood transfusion
9. test vomitus and stools for gross and occult blood
10. Urinalysis: specific gravity to check hydration status
Drugs that cause bleeding
aspirin
NSAIDs
corticosteroids
anticoagulants
How to prepare for blood transfusion
- IV lines, referably 2
- 16- or 18- gauge needle are placed for fluid and blood replacement
- oxygen supplement: face mask or nasal cannula to help increase blood oxygen saturation
Complications of blood transfusion
- fluid overload
- immunologic reactions => packed RBCs are preferred over whole blood
What is the first thing you have to do when a pt admitted with upper GI bleeding?
a thorough and accurate nursing assessment, physical needs must be met first!
What are included in the assessment for pt with upper GI bleeding?
