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Bleeding - present in 5 ways.1. Hematemesis - red blood or "coffee-ground" material.2. Melena - black, tarry, foul-smelling stool.3. Hematochezia - passage of bright red or maroon blood from the rectum.
4. Occult GI bleeding – absence of overt bleeding fecal occult blood test - +ve presence of iron deficiency.5. symptoms of blood loss or anemia light headedness, syncope, angina, or dyspnea.
I. HAEMATEMESIS• vomiting of blood follows bleeding from esophagus ,stomach and duodenum( above the duodenal flexure) COMMON CAUSESi. Ruptured oesophageal varicesii. Esophageal carcinomaiii. Chronic gastric ulcer
iv. Carcinoma stomachv. chronic duodenal ulcervi. Mallory Weiss syndromeLESS COMMON CAUSES• blood dyscrasias• Lymphoma of stomach• Anticoagulant therapy• Uraemia
• If the source of bleeding is above gastro-oesophageal sphincter ( eg : oesophageal varices) fresh blood wells up in mouth than being actively vomited
Mallory – Weiss tear-patient vomits several timesfresh blood only appearsafter the initial vomit
• Sudden loss of > 20% -tachycardia , hypotension, faintness and sweating• Brisk hematemesis -from large vessel in an ulcer BRIGHT RED• Bright red blood –naso or oro pharynx
• Slower upper GI bleeding- mixing of blood with gastric juicedarker, like that of ground coffee
II. MELAENA - black , tarry stools containing occult blood -Upper GI bleeding -Haemorrhage from right side of colon -appx 60 ml of blood - single black coloured stool
Blood for 14 hrs in the GI tract• Characteristicsi. Black tarry stool- due to production of acid haematinii. Offensive odour - acid haematin is altered by bacteriaiii. Semisolid in consistencyiv. Usually associated with vertigo , dizziness, syncopal attack during defecation
• Causes – all the causes of haematemesis may produce melaena• Rarely, swallowed blood give rise to melaena: epistaxis