Gastro Intestinal Bleeding

Introduction : GI bleeding describe is a form of haemorrhage of GI tract

from oropharynx to anus , and it is a serious condition in an individual .
It can be divided into 2 clinical syndromes
1. Upper GI bleeding ( pharynx to ligament treitz)
➢ 2. Lower GI bleeding (ligament of treitz to rectum)

Upper GI bleeding remains a major medical problems about 75% of people

have medical emergency with GI bleeding, the most common causes are
peptic ulcer ,erosions, and Mallory weirs tear and oesophageal varies .
Etiology /causes of GI bleeding
1.Oesophageal causes
➢ Oesophageal varices
➢ Oesophageal Ca
➢ Reflex oesophagitis
➢ Mallory weirs syndrome ( history of severe vomiting of blood, strong
involuntary effort to vomit of coffee ground due to excessive use of
alcohol)
2. Stomach
➢ Gastric ulcer
➢ Erosive gastritis
➢ Gastric ca
 ➢ Gastric lymphoma
➢ Gastric leiomyoma
➢ Diclofoy`s syndrome( a developmental vascular malformation of GI
tract it is an enlarged submucosal blood vessel)
3.Duodenum:
➢ Duodenal ulcer
➢ Duodenitis
➢ Periampullary tumours
➢ Aorta duodenal fistula
Clinical manifestations
➢ Haematemesis: Vomiting of blood whether it is fresh and red or
digested and black
➢ Melaena: Passage of loose black tarry stools with characteristics of
foul smell
➢ Coffee ground vomiting: blood clot in the vomitus ,comes out from
the body either with vomiting or with stools
Pathophysiology of GI bleeding
Etiology(drugs/stress/injury)

Injury in mucous layer

Untreated, unhealed injury grows towards the submucous layer

Injury of the vessels going through the submucosal layer
 Bleeding occur

Blood mix with the gastric juice content comes out body either vomiting
or with stools

Severe blood loss

Anemia ,palpitations ,hypovolemic shock

Death

Diagnostic evaluation
➢ Measure the orthostatic Hypotension
➢ Basic metabolic profile( BUN and coagulation profile)
➢ Hb% hemetocrite
➢ Endoscopy
➢ Nasogastric lavage
➢ Endoscopic angiography
➢ Barrium contrast study
➢ Ultrasonography
Management of GIB
 ➢ Assess for airway breathing circulation
➢ If not present ? compromised activate rapid response team or restore
the abc firse
➢ Fluid resuccitation by IV colloids /crystalloid transfusion
➢ Maintainence of vital signs
➢ Hemodynamic monitoring can be needed
➢ Hematochezia: Passage of bright red bld per rectum (if the
haemorrhage is severe)
➢ Haematemesis tout malaena : is generally due to lesion proximal to
the ligament of treitz since blood entering the GIT below the
duodenum rarely enters the stomach
➢ Malaena without haematemesis:It is usually due to lesions distal to
the pylorus
Approximately 60ml of blood is required to produced a single black
stool
➢ Gastric Antral Vascular ectaria
➢ Blood transfusion depending on blood reports
➢ Pain management due analgisies should be used cautiouslu
➢ Sedetives can be used but after determining level of consciousness
Medical Management
➢ Fluid replacement( to suppress growth hormones )
➢ Octerotide /Vasopressin and nitroglycerine ( to reduce the growth of
vasoactive intestinal peptide tumors (a type of varicose viens or
spider veins)
 ➢ Transjugular intrahepatic portosystemic shunt(TIPS) : is a
procedure that includes inserting a stunt or tube to connect the
portol vein to adjacent blood vessel that have lower pressure)
This relives the pressure of blood following through the diseased
liver and can help to stop bleeding
Surgical Management
Indications for surgery:
➢ Persistant hypotension
➢ Failure of medical treatment
➢ Co existing condition like perforation obstruction and
malignancy
Surgical procedures
➢ Pyloroplasty
➢ Biopsy and excision
➢ Local excision or partial gastrectomy
➢ Gastrojejunastomy
➢ GJ Vagatomy

➢Nursing care in gi bleeding

➢Assess the features of shock Start intravenous fluid
replacement Give injection adrinalline Check
hemoglobin and start transfusion as soon as possible
➢ Send blood for electrolytes
➢ Start electrolyte correction as soon as possible
 ➢ Start injection noradrinalline to maintain Bp
➢ Maintain nutrition by nasogastric or parenteral nutrition
➢ Nasogastric suction if requried

Nursing Diagnosis
1) Fluid electrolyte imbalance r/t blood loss possibly evidenced by
hematemesis melena dehydration.
2) Hypovolemic /haemorragic shock r/t severe blood loss possibly
evidenced bylow blood pressure pallor.
3) Pain in abdomen r/t gastrointestinal tract mucosa trauma or ulcer
possibly evidenced by verbalisation , facial expression.
4) Activity intolerance r/t weakness and imbalance between oxgen
supply/ demand
5) Imbalanced nutritional status r/t less then body requirement evidenced
by anorexia fatigue ,weakness.