This document discusses gastrointestinal (GI) bleeding, including its definitions, symptoms, causes, management, and prevention. GI bleeding can occur in the upper or lower GI tract, and may present as vomiting blood, black stools, or blood in the rectum. Common causes include peptic ulcers, esophageal varices, colon polyps, and diverticulosis. Management involves stabilizing the patient, stopping the bleeding, identifying the source of bleeding, and preventing recurrence. Endoscopy allows for diagnosis and potential treatment through procedures like ligation or sclerosing of varices. Surgery may be considered for severe or recurrent bleeding. Scoring systems can help determine prognosis and appropriate care settings.

1. GI BLEED

2. DEFINITIONS
 Haemetemesis – Vomiting fresh/altered blood
 Melena – Altered blood in faeces
 Hematochezia – Fresh blood/clots per rectum
 Faecal occult blood – Not visible, detected
by lab tests for RBC degradation products
 Obscure Bleeding – GI blood loss, unknown
origin, recurs/persists after intial neg
endoscopic eval.

3. SYMPTOMS
 Acute bleed – upper/lower
 Fatigue, weakness, abd pain, pallor
 Hypotension, hypovolemic shock

4. CAUSES UPPER GI
 Peptic ulcer
 Gastric or esophageal varix
 Esophagitis
 Upper gastrointestinal tract tumor
 Angioma
 Mallory-Weiss tear
 Erosions
 Dieulafoy’s lesion
 Other

5. CAUSES LOWER GI
 Diverticulosis
 Colon cancer or
polyps
 Colitis
(Noninfectious &
Infectious)
 Ischemic colitis
 IBD
 Angioectasia
 Postpolypectomy
 Rectal ulcer
 Hemorrhoids
 Anorectal source
 Radiation colitis
 Other
 Unknown

6. SCORING SYSTEM
 Rockall scoring for upper GI (0-11)
 Parameters:-
 Age
 Pulse rate
 Systolic BP
 Comorbidity
 Endoscopic Dx
 Endoscopic stigmata of recent bleed
 <3=Good, >8=Very bad

7. SCORING ALTERNATE
 Glasgow – Blatchford:-
 Whom to Rx as OP

8. MANAGEMENT
 Stabilize the patient
 Stop the bleeding
 Find the source of bleeding
 Prevent recurrence of bleeding

9. IMMEDIATE
 Assess clinical status
 PR, BP, RR, Conciousness
 Large bore IV access – 2
 Stabilize haemodynamics
 IV fluids, PRBC, Whole blood
 Vasopressors
 NG aspirate – Large bleeds, doubtful
bleeds

10. LAB TESTS
 Complete blood counts
 Hb, TC, DC, ESR
 Coag profile
 PT, INR, APTT, Platelet count
 Blood group, cross-match
 LFT
 RFT

11. SPECIAL INVESTIGATIONS
 Tagged RBC scintigraphy
 Arteriography

12. HISTORY & EXAMINATION
 Drugs – OAC, NSAID, Aspirin, Doxycycline
 Alcohol, Chronic Liver Disease
 Coagulation disorders
 Retching
 Carcinoma, Polyps
 Radiation, Surgery (abd, aortic)
 H/o embolism

13. EXTRAS
 Stop anticoagulants
 FFP
 Vit K
 Protamine (for heparin)
 Platelet conc – for low platelet count
 Enema, prokinetics
 ETT – Unconscious, severe bleed

14. SPECIALS
 Non-variceal – PPI
 Variceal -
 Octreotide (synthetic Somatostatin)
 Vasopressin
 CLD - Cephalosporins

15. INTERVENTIONS
 Endoscopy :-
 Diagnostic
 Therapeutic – Ligation, Banding, Clipping,
Sclero
 Sengstaken-Blakemore tube :-
 Variceal bleed
 Embolisation of bleeding artery

16. SURGICAL OPTION
 Indication:-
 Haemodynamic instability
 Clinical deterioration
 >6 units of transfusion
 Persistent/Recurrent bleed

17. SURGERY - HOW
 Excision
 Under-running sutures
 Ligation of artery
 TIPSS
 Splenectomy

18. OBSCURE TYPE
 Headache for gastroenterologist
 Capsule endoscopy
 Exploratory laparotomy

19. PROPHYLAXIS
 Peptic ulcer –
 PPI
 H.Pylori eradication
 Variceal –
 Β blockers
 TIPSS
 Splenectomy

20. And that is it for now