Gastrointestinal Bleeding

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  • Is an acute mucosal inflammatory process usually of a transient nature.May be accompanied by hemorrhage into the mucosa and in more severe circumstances, by sloughing of the superficial epithelium (erosion).
  • - heavy use of NSAIDs - excessive alcohol consumption - heavy smoking - treatment with cancer chemotherapy drugs - uraemia - severe stress (e.g. trauma, burns, surgery) - ischaemia and shock - suicide attempts with acid and alkali - mechanical trauma - after distal gastrectomy with reflux of bilious material
  • Rare – erosion of mucosa overlying artery in stomach causes necrosis arterial wall & resultant hemorrhage.Gastric arterial venous abnormality that has a characteristically histological apperance.The lesion itself is covered by normal mucosa and, when not bleeding, it may be invisible.If it can be seen while bleeding, all that may be visible is profuse bleeding coming from an area of apparently normal mucosa
  • inflammation and irritation of the wall of the first part of the small intestine.
  • endoscopy, may be some redness and nodules in the wall of the small intestine. - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding
  • Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of liver disease & portal hypertension: spider naevi, bruising, palmarerythema, clubbing, jaundice, hepatomegaly, ascites.Sign of GI disease: lymphadenopathy, Virchow’s node, abdominal tenderness or masses.Sign of bleeding abnormalities: telangiectasis, purpura, ecchymoses, petichiae, bleeding gums, lymphadenopathy.Bloody / black stools on per rectal examination.
  • coagulation profile – primary or secondary clotting defectsRBC morphology – hypochomic, microcytic anemia, chronic blood loss
  • Protect airway and give high-flow oxygenInsert 2 large-bore (14-16G) IV cannulate take blood for FBC, U&E, LFT, clotting, cross-match 4-6 units (1 unit per g/dL < 14g/dL)Give IV colloid while waiting for blood to be crossmatched. In a dire emergency, give group O Rh-ve blood.Transfuse until haemodynamically stable.Correct clotting abnormalities (vit K, FFP, platelet)Monitor pulse, BP, and CVP at least hourly until stable.Insert urinary catheter and monitor hourly urine output if shocked.Consider a CVP line to monitor CVP and guide fluid replacement.Organize a CXR, ECG, and check arterial blood gases in high-risk patient.Arrange an urgent endoscopy.Notify surgeon of all severe bleeds on admision.
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