Upper GI Bleed Lower GI Bleed
Upper GI bleed presents with:
Haematemesis
Colonic bleeding bright red/dark red blood per rectum
Malaena Blood in colon has a strong laxative effect rarely retained
Epigastric discomfort long enough for transformation into malaena
Sudden collapse
Oesophageal bleeding Right-sided bleeds = darker coloured blood > Left-sided
Oesophagitis small volume, fresh blood, often streaking vomit, malaena (rare),
often ceases spontaneously, usually Hx of GORD- type symptoms
Cancer small volume of blood, except as pre-terminal event w/erosion of major Colitis brisk bleeding, diarrhoea, AXR- featureless colon
vessels, associated w/ dysphagia + weight loss, recurrent until malignancy Mx
Mallory-Weiss tear brisk, small moderate volume of blood, bright red blood
Diverticular disease- acute diverticulitis sporadic bleeds,
following repeated bout of vomiting 75% will cease w/i 24-48hrs, bleeding = dark + large volume
Varices large volume of fresh blood, swallowed blood malaena, haemodynamic
compromise
Gastric bleeding Cancer bleed (1st sign)
Gastric cancer frank haematemesis/altered blood mixed w/ vomit
Prodromal features- dyspepsia + constitutional erosion of vessels haemorrhage
Dieulafoy lesion no prodromal prior to malaena + haematemesis Haemorrhoidal bright red bleeding post-defecation, rarely
AV malformation haemorrhage, difficult to detect endoscopically
Diffuse erosive gastritis haematemesis + gastric discomfort
cause haemodynamic compromise
Recent NSAID use, large volume haemorrhage + haemodynamic compromise
Gastric ulcer small low volume bleeds common IDA, erosion haematemesis +
haemorrhage
Angiodysplasia R > L
Duodenum
Major haemorrhage posterior sited duodenal ulcer
Haematemesis + malaena + epigastric discomfort
Mx
Pain occurs several hours after eating Haemorrhoids- proctosigmoidoscopy
Upper GI Bleed Mx
Angiodysplasia- angiogram (CT/percutaneous) performed
1. Admission, cross-match, check FBC, LFTs, U&Es + clotting (minimum) during period of haemodynamic instability show bleeding
2. Pts w/ on-going bleeding + haemodynamic instability O’ negative blood
3. Varices Terlipressin prior to endoscopy banded/sclerotherapy/ Sengaksten-
point show patch of angiodysplasia
Blakemore tube balloon inflation deflating after 12h to prevent necrosis Otherwise colonoscopy
4. Upper GI bleed Endoscopy w/i 24h
5. Pts w/ erosive oesophagitis/gastritis PPI
UC? Sub-total colectomy
6. Mallory-Weis resolves spontaneously
Indications for surgery
Pts > 60 yrs
Indications for surgery
Continued bleeding despite endoscopic intervention Pts > 60 yrs
Recurrent bleeding
Known CVD w/ poor response to hypotension
Continued bleeding despite endoscopic intervention
Duodenal ulcer laparotomy, duodenotomy + under-running of ulcer Recurrent bleeding
Gastric ulcer under-running of bleeding site, partial gastrectomy-antral ulcer, total
gastrectomy if bleeding persists
Known CVD w/ poor response to hypotension
Upper GI bleed presents with:
Haematemesis
Colonic bleeding bright red/dark red blood per rectum
Malaena Blood in colon has a strong laxative effect rarely retained
Epigastric discomfort long enough for transformation into malaena
Sudden collapse
Oesophageal bleeding Right-sided bleeds = darker coloured blood > Left-sided
Oesophagitis small volume, fresh blood, often streaking vomit, malaena (rare),
often ceases spontaneously, usually Hx of GORD- type symptoms
Cancer small volume of blood, except as pre-terminal event w/erosion of major Colitis brisk bleeding, diarrhoea, AXR- featureless colon
vessels, associated w/ dysphagia + weight loss, recurrent until malignancy Mx
Mallory-Weiss tear brisk, small moderate volume of blood, bright red blood
Diverticular disease- acute diverticulitis sporadic bleeds,
following repeated bout of vomiting 75% will cease w/i 24-48hrs, bleeding = dark + large volume
Varices large volume of fresh blood, swallowed blood malaena, haemodynamic
compromise
Gastric bleeding Cancer bleed (1st sign)
Gastric cancer frank haematemesis/altered blood mixed w/ vomit
Prodromal features- dyspepsia + constitutional erosion of vessels haemorrhage
Dieulafoy lesion no prodromal prior to malaena + haematemesis Haemorrhoidal bright red bleeding post-defecation, rarely
AV malformation haemorrhage, difficult to detect endoscopically
Diffuse erosive gastritis haematemesis + gastric discomfort
cause haemodynamic compromise
Recent NSAID use, large volume haemorrhage + haemodynamic compromise
Gastric ulcer small low volume bleeds common IDA, erosion haematemesis +
haemorrhage
Angiodysplasia R > L
Duodenum
Major haemorrhage posterior sited duodenal ulcer
Haematemesis + malaena + epigastric discomfort
Mx
Pain occurs several hours after eating Haemorrhoids- proctosigmoidoscopy
Upper GI Bleed Mx
Angiodysplasia- angiogram (CT/percutaneous) performed
1. Admission, cross-match, check FBC, LFTs, U&Es + clotting (minimum) during period of haemodynamic instability show bleeding
2. Pts w/ on-going bleeding + haemodynamic instability O’ negative blood
3. Varices Terlipressin prior to endoscopy banded/sclerotherapy/ Sengaksten-
point show patch of angiodysplasia
Blakemore tube balloon inflation deflating after 12h to prevent necrosis Otherwise colonoscopy
4. Upper GI bleed Endoscopy w/i 24h
5. Pts w/ erosive oesophagitis/gastritis PPI
UC? Sub-total colectomy
6. Mallory-Weis resolves spontaneously
Indications for surgery
Pts > 60 yrs
Indications for surgery
Continued bleeding despite endoscopic intervention Pts > 60 yrs
Recurrent bleeding
Known CVD w/ poor response to hypotension
Continued bleeding despite endoscopic intervention
Duodenal ulcer laparotomy, duodenotomy + under-running of ulcer Recurrent bleeding
Gastric ulcer under-running of bleeding site, partial gastrectomy-antral ulcer, total
gastrectomy if bleeding persists
Known CVD w/ poor response to hypotension
