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UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
DIGESTIVE
HEMORRHAGE
STUDENTS
William Cruz
Kevin Herrera
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

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Digestive Hemorrhage
Definition
According to their origin, they are classified as high or low digestive hemorrhage.
High hemorrhages are those that originate in the esophagus, stomach and duodenum,
and low those that originate in the rest of the small intestine and colon.
Frequently, high hemorrhages tend to have a more acute course than low ones.
In general, the symptoms are characteristic and do not give rise to doubts. What is
more problematic is determining its origin and its cause.
When there is a history of those described and the hemorrhage presents symptoms
that reveal its origin, the diagnosis is usually not difficult. However, some
hemorrhages pose a real headache for the specialist, the patient and their family,
which involves carrying out multiple tests, one after the other, without in many cases
finding the cause.

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Etiology
The digestive hemorrhage may be due to conditions that are not serious, such as:
 Anal fissure
 Hemorrhoids
However, gastrointestinal bleeding can be a sign of more serious diseases and
conditions, such as the following cancers of the digestive tract:
 Colon cancer
 Small bowel cancer
 Stomach cancer
 Intestinal polyps (a precancerous condition)
Other possible causes of gastrointestinal bleeding include:
 Abnormal blood vessels in the lining of the intestines (also called
angiodysplasia)
 Bleeding diverticulum or diverticulosis
 Crohn's disease or ulcerative colitis
 Esophageal varices
 Esophagitis
 Gastric ulcer (stomach)
 Intussusception (intestine that enters itself)
 Mallory-Weiss tear
 Meckel's Diverticulum
 Injury by radiation to the intestine
Signs and symptoms
HDA usually manifests in the form of hematemesis or melenic depositions.
Hematemesis is called vomiting of fresh blood, blood clots or dark blood remnants
("coffee grounds") and hair to the emission of stools of intense and bright black color,

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soft and very malodorous. The mane requires an extravasation of at least 60-100 ml
of blood in the upper gastrointestinal tract. Hematochezia is the externalization,
through the anus, of fresh red or dark red blood. The color of the stool is not always a
reliable indicator of the origin of the hemorrhage. Thus, the mane may appear in
hemorrhages from the small intestine or the right colon, especially if there is a slow
transit. In turn, hematochezia can be seen in massive upper gastrointestinal
hemorrhages (at least 1000 ml), usually associated with rapid transit or the presence
of a right hemicolectomy. In a series of patients with severe hematochezia, 74% had
colonic lesions (angiodysplasias, diverticula and neoplasms), 11% gastroduodenal
lesions and 9% lesions in the small intestine. In 6%, the lesion responsible for
bleeding was not proven. Often variable, depending on the amount of extravasated
blood, these findings are accompanied by those of hypovolemia and acute
posthemorrhagic anemia, such as paleness, tachycardia, cold sweats and hypotension.
It is also not unusual for a patient with severe UGIB to present with symptoms of
syncope, angina or dyspnea, before hemorrhagic externalization occurs. This form of
presentation reflects the existence of a cerebral oxygenation, myocardial failure or
respiratory insufficiency, which, by themselves, are indicative of severity. Such a
situation should be suspected in any patient who presents, in addition to the signs
mentioned, those typical of acute posthemorrhagic anemia. The previous or recent
intake of NSAID increases the likelihood that these symptoms are due to a non-
externalized HDA.
Diagnosis
When bleeding occurs at a point in the gastrointestinal tract that is accessible to
gastroscopy or colonoscopy (esophagus, stomach, duodenum, colon, or last small
bowel portion), these are the most useful method. An endoscopy will in most cases
reach the point of bleeding, to establish its cause and, in many cases, will serve to
apply an effective treatment to cut it.

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If gastroscopy and colonoscopy do not provide information on the origin of the
bleeding (approximately 5% of the time), an exploration of the entire small intestine
is performed using the endoscopic capsule.
When endoscopy diagnosis is not reached, other techniques that help are
arteriography (catheterization of arteries and veins of the abdomen), scintigraphy with
marked red blood cells, the radiological study of the digestive tract with barium, the
scanner and in extreme cases , surgical exploration.
Anyway, in the face of acute or chronic bleeding, all the diagnostic possibilities must
always be exhausted given the high risk they present and the severity of some of their
causes.
Treatment
1.- Initial stabilization
All patients with suspected or confirmed HDA will be placed at least one large-gauge
peripheral route. In some cases, when they meet clinical criteria of severity (table I),
it may be necessary to place two peripheral routes and / or a central venous line.
Once the venous access is assured, the infusion of EV liquids will begin, initially with
saline. In cases in which massive hemorrhage is suspected or in stable cases in which
a hemoglobin lower than 8 g / dl is observed, the transfusion of packed red blood
cells can be considered.
Once the patient is stabilized, endoscopy will be performed, which provides the
diagnosis in most cases and allows local treatment. If bleeding is suspected due to
portal hypertension, a 250 μg somatostatin bolus is administered, followed by a
continuous infusion of 3 mg / 12 hours. After its realization, depending on the
findings, the patient's admission is decided in the most appropriate unit, where the
second treatment phase will proceed
2.- Treatment in UCE
Patients who enter the Digestive, UMI or Surgery will receive the treatment indicated
by the responsible specialist.

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Patients admitted to UCE will be managed according to the following scheme:
On a diet
Absolute diet will be indicated until the completion of the endoscopy.
The cases in which the endoscopy is not conclusive and it is necessary to repeat it at
24 hours, should remain on an absolute diet.
In stable patients with low risk lesions and without active bleeding, the administration
of an ulcus diet can be indicated two hours after the endoscopy.
In patients with peptic ulcer without signs of recent bleeding, or in those in whom
local endoscopic treatment has been applied, absolute diet will be indicated at least
during the first 24 hours. The persistence of bleeding should be monitored by
observing the stool and determining blood urea, and keeping the patient on a diet
until the bleeding has disappeared.
B.- Serum therapy
Patients who remain on an absolute diet will receive at least 2500 cc of glucosaline
serum in 24 hours. According to the estimate of the volume lost (table I), these
requirements may be higher, and it may even be necessary to transfuse red blood
cells.
C.- Pharmacological treatment
The most frequent causes of HDA susceptible to admission to the ECU are those due
to gastroduodenal ulcus, esophagitis, Mallory-Weiss syndrome, and acute gastric
mucosal lesions due to gastroerosives. In these cases it is indicated to use drugs that
decrease the acid secretion of the stomach. They will be used, when possible orally.
In patients who must remain on an absolute diet, the intravenous route will be used.
Proton pump inhibitors (omeprazole and the like) will be used.
Prevention
Acute gastrointestinal hemorrhage can occur in any patient who has, in his or her
background or at the present time, any of the causes described above.
Especially:

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 People with a history of duodenal or gastric ulcer, especially if they take anti-
inflammatory drugs.
 Patients with cirrhosis who have large varices in the esophagus or stomach.
 People who have severe vomiting, especially if they are due to excessive
alcohol intake.
 The elderly with diverticula or angiodysplasias.
 Patients with valvular diseases of the heart, especially if they take
anticoagulants.
 People with advanced kidney failure.
 Patients who have undergone an endoscopy in which polyps have been
removed.
 People who take anti-inflammatories, antiaggregants or anticoagulants,
especially if they are elderly or have other associated cause.
Bibliography
 Herrera A, Bejarano M. Use of prophylactic drugs for gastrointestinal
hemorrhage in hospitalized patients at the Rafael Uribe Uribe Clinic in Cali.
Rev Col Gastroenterol 2009; 24: 340-346.
 Barkun AN, et al. Review article: acid suppression in non variceal acute upper
gastrointestinal bleeding. Aliment Pharmacol Ther 1999; 13 (2): 1505-84.
 Cook DJ, et al. Risk factors for gastrointestinal bleeding in critically ill
patients. Canadian critical care trials group. N Eng J Med 1994; 330 (6): 377-
81.