Gastrointestinal bleeding resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Definition

Gastrointestinal bleeding refers to any bleeding that occurs in gastrointestinal tract from the pharynx to the rectum.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Esophageal varices
• Gastric ulcer
• Gastric varices
• Aorto-enteric fistula
• Hemosuccus pancreaticus
• Superior mesenteric artery syndrome

Common Causes

• Upper gastrointestinal bleeding
  • Duodenal ulcer
  • Esophageal ulcer
  • Esophageal varices
  • Gastric ulcer
  • Gastritis
  • Mallory-Weiss tear
• Lower gastrointestinal bleeding
  • Angiodysplasia
  • Anal fissure
  • Colonic polyps
  • Diverticulitis
  • Diverticulosis
  • Hemorrhoids
  • Infectious colitis
  • Infectious diarrhea
  • Inflammatory bowel disease
  • Ischemic colitis

Management

Shown below is an algorithm summarizing the approach to [[Initial work up of GI bleed]].

GI bleed

Assess airway, intubate if required Assess circulation, 2IV bore lines 500ml NS nil per oral start PPI infusion (80mg bolus followed by 8mg/h infusion)

Send CBC, PT/PTT blood type and cross match

UGIB management see below

LGIB management see bwlow

Shown below is an algorithm summarizing the approach to [[Upper GI bleed]]

Initial work up, see above

UGIB

Early EGD

Lesion not localised

Lesion localised

Consider mid/ lower GI bleed

Peptic ulcer disease

Varices

Esophagitis/Gastritis

Mallory-Weiss tear

Active bleeding/ Non bleeding visible vessel

Adherent clot

Flat spot/ clean base

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Endoscopic therapy + IV PPI therapy

+/- Endoscopic therapy + IV PPI therapy

No endoscopic therapy, no IV PPI therapy

Ligation/ sclerotherapy

PPI therapy

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References

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