SHM's Clinical Quick Talks-Gastrointestinal Hemorrhage

Pdf Summary

Gastrointestinal hemorrhage is a serious condition that requires prompt medical attention. There are approximately 350,000 hospital admissions in the US annually for gastrointestinal bleeding (GIB), with an estimated mortality rate ranging from 2-15%. Acute, massive upper gastrointestinal bleeding (UGIB) occurs at a rate of 40 to 150 episodes per 100,000 persons annually, while acute, massive lower gastrointestinal bleeding (LGIB) occurs at a rate of 20 to 27 episodes per 100,000 persons annually.<br /><br />The most common causes of acute UGIB include peptic ulcer disease (PUD), gastritis/duodenitis, and esophageal varices. Acute LGIB is often caused by diverticular disease, colonic neoplasms, arteriovenous malformations (AVMs), and colitis.<br /><br />Patients with gastrointestinal hemorrhage may present with microscopic blood loss (hemoccult positive stool or iron deficiency anemia), hematemesis (vomiting fresh blood), "coffee-ground" emesis (black, digested blood), melena (black, tarry stool), or hemochezia (bright red blood via rectum). Initial evaluation typically includes lab tests such as CBC, coagulation studies, and type and cross. Additionally, the patient's history, including use of NSAIDs and other anticoagulants, alcohol intake, and prior GI bleeds or surgeries, is important in assessing the cause and severity of the bleeding.<br /><br />The diagnosis of UGIB is usually made through esophagogastroduodenoscopy (EGD), while colonoscopy is the diagnostic tool of choice for LGIB. Other diagnostic tools include arteriography, technetium-99m-tagged RBC scan, and double-contrast barium enema with sigmoidoscopy. For small bowel bleeding, push enteroscopy, barium-contrast upper GI series with small bowel follow-through, enteroclysis, technetium-99m-tagged RBC scan, and capsule endoscopy can be used.<br /><br />The treatment of gastrointestinal hemorrhage is determined by the stability of the patient and the rate of bleeding. Hemodynamically unstable patients require resuscitation with IV fluids and blood transfusions. Prophylactic antibiotics, somatostatin analogs, and proton pump inhibitors (PPIs) may be used in certain cases to control bleeding and prevent complications. The timing of endoscopy depends on the patient's stability and comorbidities.<br /><br />The Rockall Score is a useful tool to predict the mortality rate in GI bleeding, while the Blatchford Score is helpful in assessing the need for endoscopy to identify high-risk lesions.<br /><br />In summary, prompt evaluation, accurate diagnosis, and appropriate treatment strategies are crucial for managing gastrointestinal hemorrhage and improving patient outcomes.

Asset Subtitle

Salim Rezaie

Keywords

gastrointestinal hemorrhage

hospital admissions

mortality rate

upper gastrointestinal bleeding

lower gastrointestinal bleeding

causes of bleeding

diagnostic tools

treatment of hemorrhage

Rockall Score

Blatchford Score