GI Bleeding

Categories of GI Bleeding: Upper vs. Lower GI Bleeding

Upper GI Bleeding:

• Involves bleeding from the esophagus through the duodenum.

• Common Causes:

  • Esophageal Varices: Engorged veins in the esophagus, often due to chronic conditions such as liver cirrhosis or portal hypertension, leading to increased pressure and potential rupture.

  • Peptic Ulcer Disease: Includes both gastric (stomach) ulcers and duodenal ulcers, often brought on by infection with H. pylori or long-term use of NSAIDs.

• Symptoms and Terms:

  • Hematemesis: Vomiting blood; can appear as coffee ground emesis, indicating digestion of blood before vomiting.

  • Hematochezia: Presence of bright red or maroon blood in the stool; typically indicates rapid bleeding from the lower part of the GI tract but can appear in upper GI cases if bleeding is severe.

  • Melena: Black, tarry, foul-smelling stool, indicating digested blood. Melena is typically a result of bleeding above the ligaments of Treitz.

Lower GI Bleeding:

• Involves the jejunum down to the anus.

• Common Causes:

  • Frequently associated with diverticular disease, colonic polyps, colorectal cancer, or inflammatory bowel disease (IBD).

• Symptoms and Terms:

  • Hematochezia is the hallmark symptom of lower GI bleeding and may be accompanied by abdominal pain.

  • Hematemsis is rare in lower GI bleeding.

• Characteristics of Bleeding:

  • Generally, upper GI bleeding tends to be more rapid and riskier compared to lower GI bleeding.

  • Finding the underlying cause for bleeding is essential; blood may be occult (not grossly visible), detected via stool tests and diagnostic imaging.

Cholecystitis

• Definition: Inflammation of the gallbladder, often due to obstruction.

• Common Cause: Gallstone obstruction of the cystic duct; about 90% of cases arise from stone obstruction, but other factors like infections or tumors may contribute.

• Symptoms:

  • Initially presents as epigastric pain that may migrate to the right upper quadrant.

  • Pain in the right upper quadrant is often severe and can radiate to the right shoulder or back; associated with symptoms of nausea, vomiting, and sometimes fever.

• Treatment:

  • Cholecystectomy: Surgical removal of the gallbladder is a common intervention, particularly if cases are recurrent or diagnosed as acute cholecystitis.

Appendicitis

• Definition: Inflammation of the appendix, a small appendage off the cecum of the large intestine.

• Location: Typically situated in the right lower abdominal quadrant.

• Presentation:

  • Presents as sharp right lower quadrant pain which can begin around the umbilical area before localizing.

  • Associated with elevated white blood cell count and potential fever.

  • Crucial symptom sequence: Pain often precedes vomiting; if vomiting occurs prior to pain, it may indicate bowel obstruction.

• Treatment:

  • Appendectomy: Required to prevent rupture, which leads to complications like peritonitis and sepsis.

Bowel Obstruction

• Common Types: Small bowel obstruction (SBO) and large bowel obstruction (LBO).

• Prevalence: SBO is far more common than LBO, accounting for about 90% of all obstruction cases.

• Common Causes:

  • SBO: Frequently due to adhesions (scar tissue) from previous surgeries, hernias, or tumors.

  • LBO: Most commonly due to colon cancer, but can also be caused by diverticular disease and volvulus.

• Types of Obstruction:

  • Partial Obstruction: Some material can still pass, leading to symptoms like crampy abdominal pain, bloating, and intermittent constipation.

  • Complete Obstruction: Blockage prevents any movement of content, leading to severe abdominal pain, distension, and requires emergent treatment to prevent serious complications.

This comprehensive overview on gastrointestinal bleeding, cholecystitis, appendicitis, and bowel obstruction provides important details on definitions, causes, symptoms, and treatments, aiding in the understanding and diagnosis of these medical conditions.