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What should you be able to elaborate about a medical condtion?
What is it?
What causes it?
What complications can occur?
What are the risk factors?
What's normal?
How is it diagnosed?
What are the symptoms?
What are the signs?
What are the clinical findings?
What are the lab or investigation findings?
How many such cases occur worldwide every year?
How has diagnosis and treatment of this medical condition evolved?
What medical history should you seek relevant to this issue?
What happens in this medical condition?
What research is being done on this issue?
How can I help?
How can you help?
How is this medical condition reported?
What should happen before reporting this medical condition?
What are the types of this medical condition?
What is the treatment?
What are the workable treatment options?
When is counseling required?
When is medication required?
How long should medication last?
What type of medication is available?
How could this be prevented?

Upper Gastrointestinal Bleeding
Lower Gastrointestinal Bleeding

Annotation or Definition

Definition

What is Gastrointestinal Bleeding?
Gastrointestinal bleeding refers to any form of hemorrhage or blood loss that occurs in the gastrointestinal tract, the passage that extends all the way from the mouth to the anus.

The causes of this type of bleeding are numerous but a patient’s symptom history and a physical examination usually help to distinguish the main causes. Bleeding can range in severity form mild or almost undetectable through to acute and life-threatening.

The upper digestive tract includes the food pipe (esophagus), the stomach and upper part of the first portion of the small intestine (duodenum). The lower digestive tract comprises the majority of the small intestine, all of the large intestine, the rectum and the anus.

Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract.

Bleeding may come from any site along the GI tract, but is often divided into:

Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine. Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.

How to differentiate between upper or lower bleeding?

Symptoms
Some of the symptoms of upper gastrointestinal bleeding include:
•Blood in the vomit
•Coffee ground appearance of vomit
•Black, tarry stool
•Bright red blood in stool
Some of the symptoms of lower gastrointestinal bleeding include:

•Black, tarry stool
•Bright red blood in stool
•Severe bleeding may lead to anemia, weakness, abdominal pain and diarrhea

Medical history relevant to this medical condition

When did you first notice symptoms?
Did you have black, tarry stools or red blood in the stools?
Have you vomited blood?
Did you vomit material that looks like coffee grounds?
Do you have a history of peptic or duodenal ulcers?
Have you ever had symptoms like this before?
What other symptoms do you have?

Causes

What causes gastrointestinal bleeding?

45 possible conditions

Upper GI bleeding

Peptic ulcer disease
Gastritis
Esophageal varices
Angiomata
Cancer
Mallory Weiss tear
Inflammation

•Peptic ulcer disease: Peptic ulcers are localized erosions of the mucosal lining of the digestive tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, causing bleeding.
•Gastritis: General inflammation of the stomach lining, which can result in bleeding. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces. NSAIDs (nonsteroidal anti-inflammatory drugs), steroids, alcohol, burns, and trauma can cause gastritis.
•Esophageal varices: Swelling of the veins of the esophagus or stomach usually resulting from liver disease. Varices most commonly occur in alcoholic liver cirrhosis. When varices bleed, the bleeding can be massive, catastrophic and occur without warning.
•Mallory-Weiss tear: A tear in the esophageal or stomach lining, often as a result of vomiting or retching. Mucosal tears also can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth. Physicians often find tears in people who have recently binged on alcohol.
•Cancer: One of the earliest signs of esophageal or stomach cancers may be blood in the vomit or stool.
•Inflammation: when the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, and cigarette smoking promote gastric ulcer formation. Helicobacter pylori is a type of bacteria that also promotes formation of ulcers.

Lower GI bleeding

•Diverticulosis: One of the most common causes of lower GI bleeding. Small out-pockets, or diverticula, form in the wall of the colon (large intestine), usually in a weakened area of the bowel wall. The person may develop several pockets, which are more common in people who have constipation and strain during a bowel movement.
•Cancers: One of the early signs of colon or rectal cancers may be blood in the stool. •Inflammatory bowel disease (IBD): Flares of inflammation from IBD often cause mucousy stool that has blood mixed in it.
•Infectious diarrhea: Some viruses or bacteria can cause damage to the inner lining of the intestines, which can lead to bleeding.
•Angiodysplasia: Along with diverticulosis, this is one of the most common causes of lower GI bleeding. Angiodysplasia is a malformation of the blood vessels in the wall of the GI tract. These are most commonly in the large intestine and often bleed. The elderly and people with chronic kidney failure develop the disease most often.
•Polyps: Intestinal polyps are noncancerous tumors of the GI tract, occurring mostly in people older than 40 years of age. A small proportion of these polyps may transform into cancer. Colon polyps may bleed rapidly, or they may bleed slowly and go undetected.
•Hemorrhoids and fissures: Hemorrhoids are swollen veins in and around the anus. Repeated stretching from straining during bowel movements causes them to bleed. Bleeding from hemorrhoids is usually mild, intermittent, and bright red. Anal fissures, or tears in the anal wall, also may trigger small amounts of bright red bleeding from the anus. Forceful straining during passage of hard stool usually causes such tears, which can be very painful and may require surgery.
•Radiation injury to the bowel

Diagnosis

Diagnosis is usually made after taking a detailed patient history and performing a physical and clinical examination. Diagnosis commonly involves an endoscopy procedure. For an upper gastrointestinal endoscopy, a tube with a camera and a light source at its tip (endoscope) is passed down the esophagus and used to look for the site and cause of the bleeding. One of the most common causes of this type of bleeding is peptic ulcer. The lower gastrointestinal tract is examined using colonoscopy, which uses similar principles but is performed using an endoscope that is inserted via the rectum.

What is the treatment?
What are the workable treatment options?
Treatment

Treatment is initially focused on fluid resuscitation to replenish bodily fluids lost through bleeding in order to prevent hypovolemia or shock. Depending on the cause and site of the bleeding, various different treatment approaches are used. For example, bleeding caused by peptic ulcer may be controlled using proton pump inhibitors while colonoscopy with cauterization may be required to treat lower gastrointestinal bleeding. Who needs immediate upper GI endoscopy and who can wait?

Remember that 80% of all UGB stop spontaneously

What about continued treatment of Ulcers after Bleeding stops?
Here are further guidelines.