Gastrointestinal bleeding 904585 216147983 2008-05-31T08:22:57Z Thijs!bot 1392310 robot Adding: [[pl:Krwawienie z przewodu pokarmowego]] {{Infobox_Disease | Name = Gastrointestinal bleeding | Image = | Caption = | DiseasesDB = 19317 | ICD10 = {{ICD10|K|92|2|k|90}} | ICD9 = {{ICD9|578.9}} | ICDO = | OMIM = | MedlinePlus = 003133 | eMedicineSubj = radio | eMedicineTopic = 301 | eMedicine_mult = {{eMedicine2|radio|302}} {{eMedicine2|emerg|381}} | MeshID = D006471 | }} '''Gastrointestinal bleeding''' or '''gastrointestinal hemorrhage''' describes every form of [[hemorrhage]] (loss of [[blood]]) in the [[gastrointestinal tract]], from the [[pharynx]] to the [[rectum]]. It has diverse causes, and a medical history, as well as [[physical examination]], generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding. Initial emphasis is on resuscitation by infusion of [[intravenous therapy|intravenous fluids]] and [[blood transfusion]], treatment with [[proton pump inhibitor]]s and occasionally with [[vasopressin]] analogues and [[tranexamic acid]]. [[Upper endoscopy]] or [[colonoscopy]] are generally considered appropriate to identify the source of bleeding and carry out therapeutic interventions. ==Symptoms and signs== Gastrointestinal bleeding can range from microscopic bleeding, where the amount of blood is so small that it can only be detected by laboratory testing (in the form of [[iron deficiency anemia]]), to massive bleeding where pure blood is passed and [[hypovolemia]] and [[Shock (medical)|shock]] may develop, risking [[death]]. ==Classification== Gastrointestinal bleeding can be roughly divided into two clinical syndromes. ===Upper gastrointestinal bleeding=== {{main|upper gastrointestinal bleeding}} Upper gastrointestinal bleeding is from a source between the [[pharynx]] and the [[Suspensory muscle of the duodenum |ligament of Treitz]]. An upper source is characterised by [[hematemesis]] (vomiting up blood) and [[melena]] (tarry stool containing altered blood). ===Lower gastrointestinal bleeding=== {{main|Lower gastrointestinal bleeding}} Lower gastrointestinal bleeding may be indicated by red blood ''per rectum'', especially in the absence of [[hematemesis]]. Isolated melena may originate from anywhere between the stomach and the proximal colon. ==Treatment== ===Early management=== Initial focus in any patient with a form of gastrointestinal hemorrhage is on [[resuscitation]], as any further intervention is precluded by the presence of intravascular depletion or [[Shock (medical)|shock]]. * ''Fluid resuscitation:'' [[intravenous fluids]] and [[blood transfusion]] may be administered. * ''Acid suppression'': in an upper GI source, [[proton pump inhibitor]]s reduce [[gastric acid]] production and enhance healing of bleeding lesions. * ''Inhibition of fibrinolysis'': in ongoing bleeding, [[tranexamic acid]] reduces [[fibrinolysis]] and may decrease blood product requirements. * ''Correction of coagulopathy'': if [[coagulation]] parameters (e.g. [[prothrombin time]]) are deranged, [[vitamin K]] or [[fresh frozen plasma]] may need to be administered. * ''Reduction of portal pressure'': if the bleeding is thought to be due to [[esophageal varices]] (a complication of [[cirrhosis]] of the liver), [[vasopressin]] analogues and rarely [[octreotide]] may be administered. Rarely, a [[Sengstaken-Blakemore tube]] may be inserted to mechanically compress varices. * ''Urgent endoscopy'': if the bleeding cannot be managed medically an urgent [[esophagogastroduodenoscopy]] (EGD/OGD) may identify sources of bleeding. This is a high-risk procedure best performed under safe circumstances in the [[intensive care unit]] or [[operating theatre]]s. * ''Surgical intervention'': in extreme cases of bleeding, [[laparotomy]] may be required to identify the bleeding source. ===Endoscopy=== After adequate stabilization, [[endoscopy]] ([[upper endoscopy]] and/or [[colonoscopy]]) are used to identify the source of bleeding. Injection, sclerotherapy, electrocoagulation, vascular clipping and biopsy may be performed. Endoscopy is also useful in setting the indication for therapy, e.g. the need for long-term [[proton pump inhibitor]] therapy, presence of [[esophageal varices]], [[adenomatous polyp]]s and so on. ==References== * Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. ''Postgrad Med J'' 2002;78:4-14. PMID 11796865. {{Gastroenterology}} [[Category:Surgery]] [[Category:Gastroenterology]] [[Category:Conditions diagnosed by stool test]] [[de:Gastrointestinale Blutung]] [[fr:Hémorragie digestive]] [[pl:Krwawienie z przewodu pokarmowego]] [[pt:Sangramento gastrointestinal]]