Gastrointestinal Hemorrhage
Gastrointestinal bleeding orgastrointestinal hemorrhage describes every form of
hemorrhage (loss of blood)in the gastrointestinal tract, from the pharynx to the rectum
Hematemesis
•means vomiting blood -it is due to an upper GI bleed, proximal to the duodenojejunal
junction
•It can be frank red blood or "coffee-ground" vomitus.
"coffee-ground" vomitus
-it is degraded by exposure to gastric contents with conversion of Hb to met Hb
Melena
•black stools results from bleeding proximal to the ileocaecal valve, but sometimes from
the
•the black colouris due to haematin resulting from the oxidation of haemby intestinal
and bacterial enzymes
•may persist for several days after the bleed has stopped.
Haematochezia
•passage of fresh red blood rectally
•almost always denotes bleeding from the colon, but if the bleeding is very active, it may
result from an upper GI source.
Occult blood
•occult blood denotes the invisible loss of blood from the gastrointestinal tract
•most commonly identified by a positive guaiac testing of faeces.
Massive Persistent Bleed
•collapsed state with hypovolaemicshock, having had profuse melaenaor
haematocheziawith or without haematemesis.
•If the patient remains unstable, there is no opportunity for detailed investigation
1
, –Do not delay emergency surgery
Hypovolaemic Shock
•The cardiovascular response to blood loss is related to
–the size of the bleed
–the rate of bleeding
– The general condition and comorbidity of the patient.
•Greater than 25% intravascular volume, over several hours
Significant Bleed, Haemodynamically Stable
•Particularly in the younger age group
•Admit these patients and try to find the source of bleeding.
Minor Rectal Bleeding
•Minor rectal bleeding is common and it is usually attributable to minor anal pathology
•BUT !! could indicate significant colorectal disease. –You must exclude this possibility.
Guaiac
•Turns blue after oxidation by oxidants or peroxidases in the presence of an oxygen
donor such as hydrogen peroxide.
•Identifying a loss of 10-50 ml/day
•Melaena is noticeable at a rate of 50-100 ml/day.
Asymptomatic Patient with Positive Occult Blood Stools
•Investigation requires a full colonoscopy with positive identification of the caecum and,
if this is negative, at least an upper endoscopy with or without a small bowel barium
study.
2
Gastrointestinal bleeding orgastrointestinal hemorrhage describes every form of
hemorrhage (loss of blood)in the gastrointestinal tract, from the pharynx to the rectum
Hematemesis
•means vomiting blood -it is due to an upper GI bleed, proximal to the duodenojejunal
junction
•It can be frank red blood or "coffee-ground" vomitus.
"coffee-ground" vomitus
-it is degraded by exposure to gastric contents with conversion of Hb to met Hb
Melena
•black stools results from bleeding proximal to the ileocaecal valve, but sometimes from
the
•the black colouris due to haematin resulting from the oxidation of haemby intestinal
and bacterial enzymes
•may persist for several days after the bleed has stopped.
Haematochezia
•passage of fresh red blood rectally
•almost always denotes bleeding from the colon, but if the bleeding is very active, it may
result from an upper GI source.
Occult blood
•occult blood denotes the invisible loss of blood from the gastrointestinal tract
•most commonly identified by a positive guaiac testing of faeces.
Massive Persistent Bleed
•collapsed state with hypovolaemicshock, having had profuse melaenaor
haematocheziawith or without haematemesis.
•If the patient remains unstable, there is no opportunity for detailed investigation
1
, –Do not delay emergency surgery
Hypovolaemic Shock
•The cardiovascular response to blood loss is related to
–the size of the bleed
–the rate of bleeding
– The general condition and comorbidity of the patient.
•Greater than 25% intravascular volume, over several hours
Significant Bleed, Haemodynamically Stable
•Particularly in the younger age group
•Admit these patients and try to find the source of bleeding.
Minor Rectal Bleeding
•Minor rectal bleeding is common and it is usually attributable to minor anal pathology
•BUT !! could indicate significant colorectal disease. –You must exclude this possibility.
Guaiac
•Turns blue after oxidation by oxidants or peroxidases in the presence of an oxygen
donor such as hydrogen peroxide.
•Identifying a loss of 10-50 ml/day
•Melaena is noticeable at a rate of 50-100 ml/day.
Asymptomatic Patient with Positive Occult Blood Stools
•Investigation requires a full colonoscopy with positive identification of the caecum and,
if this is negative, at least an upper endoscopy with or without a small bowel barium
study.
2
