Gastrointestinal Hemorrhage (GI bleed)

week 11

GI Bleed - Definition

Loss of blood from any part of the GI tract, which can lead to decreased circulating volume & impaired tissue perfusion

GI Bleed - Pathophysiology

GI bleed (diverticulosis, peptic ulcer, esophageal varices, colon cancer, haemorrhoids) → Blood loss → Hemodynamics change (low CO, hypotension, tachycardia) → Body compensation → (skin is pale and cool; decreased urine output; low GI perfusion) → Low organ perfusion → Cellular hypoxia → Anaerobic metabolism (metabolic acidosis) → Compensatory failure → Multi-organ failure, shock, death

GI Bleed - Etiologies

• NSAIDs & Anticoagulants

• H. pylori & peptic ulcer

• Colorectal cancer / IBD

• Alcohol use disorder

• Liver disease

• Trauma/stress

GI Bleed - Diagnostic tests

• CBC, hgb, platelets, hematocrit

• Electrolyes/chemistry - BUNS, creatinine, K+, GFR

• aPTT/INR

• Fecal occult blood

• Endoscopy

• CT Angiography/colonoscopy

GI Bleed - Upper GI clinical presentation

Hematemesis (vomiting blood)

• Bright red (active/fresh bleed)

• Coffee-ground (digested blood/gastric acid contact)

Melena (Black, tarry, foul-smelling stools)

• Indicates blood digestion

• Usually from upper GI source

• Can persist for days after bleeding stops

GI Bleed - Lower GI clinical presentation

Hematochezia (bright red blood per rectum)

• Usually lower GI source

• Can be massive upper GI bleed with rapid transit

• Associated with clots

GI Bleed - Upper

Anatomical location - esophagus, stomach, duodenum

Common sources - Peptic ulcers, esophageal varices, gastritis

Presentation - hematemesis, melon

GI Bleed - Lower

Anatomical location - Jejunum, ileum, colon, rectum

Common sources - Diverticulosis, hemorrhoids, colorectal cancer, angiodysplasia

Presentation - hematochezia, occult blood

GI Bleed - Complications

• Severe anemia (fatigue, pallor, chest pain)

• Electrolyte imbalance (hypokalemia, metabolic acidosis)

• Aspiration pneumonia (if vomiting blood)

GI Bleed - Assessment priorities

• Frequent vitals - tachycardia, hypotension, orthostatic BP

• Perfusion status - LOC, skin colour/temp, cap refill

• Abdominal exam - distension, rigidity (perforation risk), tenderness

• Monitor labs (electrolytes, BUN, GFR)

• Medication review - anticoagulants, antiplatelets, NSAIDS

• History risk factors (e.g., alcohol use, liver disease, previous GI bleeds)

GI Bleed - Interventions

NPO status for potential endoscopy/surgery, reduce risk of aspiration

Fluid resuscitation - 2 large-bore IVs (18G or larger) to maintain BP

Monitor bleeding

High Fowler’s to aid breathing - place in lateral position if vomiting

Oxygen therapy

Safety & support - Fall precautions, emotional reassurance

GI Bleed - Chronic management

• Avoid risk factors - NSAIDs, alcohol, smoking

• Medical follow up - crucial if source was cancerous or liver disease related

• Specialist referrals

• Dietary support - adjust diet post-bleed