This article presents a practical overview of the approach to managing a patient presenting with nonvariceal upper gastrointestinal bleeding (NVUGIB). [ncbi.nlm.nih.gov]

Lower GI bleeding classically presents with hematochezia, however bleeding from the right colon or the small intestine can present with melena[ 31 ]. [dx.doi.org]

• Anemia

  Microcytic red blood cells or iron deficiency anemia suggests chronic bleeding. [dx.doi.org]

  Although severe anemia can theoretically result in anemic hypoxia, vulnerable pallidal lesions have rarely been described in anemic patients. [ncbi.nlm.nih.gov]

  Hospitalization is essential to monitor for signs of hemodynamic instability and shock caused by anemia and blood loss, which require swift intervention. [amboss.com]

• Fever

  Colonoscopy (examination of the entire large intestine, rectum, and anus using an endoscope) Inflammation of the large intestine due to radiation therapy, infection, or disruption of the blood supply (as occurs in ischemic colitis) Bloody diarrhea, fever [msdmanuals.com]

  RESULTS: Among 175 patients with GI bleeding, dengue hemorrhagic fever was found in 119 (68%) patients; the median duration from onset dengue illness to GI bleeding was 5 days. [ncbi.nlm.nih.gov]

  […] vessel rupture as a result of high blood pressure, aneurysms, esophageal varices, peptic ulcers, or ectopic pregnancy. [6] Other diseases linked to internal bleeding include cancer, hematologic disease, Vitamin K deficiency, and rare viral hemorrhagic fever [en.m.wikipedia.org]

• Weight Loss

  Weight loss: Dramatic and sudden weight loss might occur. A cough: This becomes more common when trying to swallow. Sometimes, the individual wmay cough up blood. Voice changes: The voice may become hoarse. [medicalnewstoday.com]

  Weight loss and anorexia, with or without a change in stool, suggest a GI cancer. A history of cirrhosis or chronic hepatitis suggests esophageal varices. Dysphagia suggests esophageal cancer or stricture. [msdmanuals.com]

  “In addition to age, we have to take into account the amount of bleeding, the necessity of blood transfusions, concomitant diseases and associated symptoms like weight loss. [acphospitalist.org]

• Pallor

  Seek immediate medical care (call 911) for serious symptoms, pale skin or pallor and difficulty breathing, severe abdominal pain, vomiting blood or black material, or change in level of consciousness. [healthgrades.com]

  General examination focuses on vital signs and other indicators of shock or hypovolemia (eg, tachycardia, tachypnea, pallor, diaphoresis, oliguria, confusion) and anemia (eg, pallor, diaphoresis). [msdmanuals.com]

  - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of [slideshare.net]

• Acutely Ill Patient

  Primary prophylaxis for acutely ill patients in critical care: [ 2 ] Acid-suppression therapy (H 2 -receptor antagonists or PPIs) should be offered for primary prevention of UGIB in acutely ill patients admitted to critical care (using the oral form of [patient.info]

  Common Causes of Gastrointestinal (GI) Bleeding In acutely ill patients, stabilization with airway management, IV fluids, or transfusions is essential before and during diagnostic evaluation. [msdmanuals.com]

• Dyspnea

  Two days after admission, we initiated hemodialysis for persistent oliguria and progression of dyspnea. Following this, he received regular hemodialysis and antibiotics. [ncbi.nlm.nih.gov]

  Younger patients or those with chronic bleeding are usually not transfused unless hematocrit is < 23 or they have symptoms such as dyspnea or coronary ischemia. [msdmanuals.com]

• Melena

  Five months after the surgery, she was re-admitted because of melena and anemia. Ultrasonography showed a gallbladder tumor with gastrointestinal hemorrhage, and laparoscopic-assisted cholecystectomy was subsequently performed. [ncbi.nlm.nih.gov]

  […] blood on stools ) Melena may be caused by upper as well as lower gastrointestinal blood loss! [amboss.com]

  Classically presents with hematemesis and/or melena. Although hematemesis and melena suggest a more proximal source, 15% of patients with upper GI bleeding present with hematochezia. Slow bleeding may cause iron deficiency anemia 4. [radiopaedia.org]

  The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. [doi.org]

• Hematochezia

  Depending on the source of the bleeding and how long the blood remains in the digestive tract, clinical symptoms may include vomiting blood ( hematemesis ), black, tarry stool ( melena ), and fresh blood in stools ( hematochezia ). [amboss.com]

  The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. [doi.org]

  Conclusion Severe hematochezia is a potential surgical emergency with a broad differential diagnosis. [mdedge.com]

  Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. [ncbi.nlm.nih.gov]

• Hematemesis

  Classically presents with hematemesis and/or melena. Although hematemesis and melena suggest a more proximal source, 15% of patients with upper GI bleeding present with hematochezia. Slow bleeding may cause iron deficiency anemia 4. [radiopaedia.org]

  Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). [doi.org]

  Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. [ncbi.nlm.nih.gov]

  Depending on the source of the bleeding and how long the blood remains in the digestive tract, clinical symptoms may include vomiting blood ( hematemesis ), black, tarry stool ( melena ), and fresh blood in stools ( hematochezia ). [amboss.com]

  Patients with hematemesis should be asked whether blood was passed with initial vomiting or only after an initial (or several) nonbloody emesis. [msdmanuals.com]

• Gastropathy

  […] intervention/polypectomy Anastomotic bleeding following surgery (e.g., gastric bypass surgery, Billroth II surgery ) Ingestion of foreign bodies Following interventions such as polypectomy or biopsy Post-surgery anastomotic bleeding Further Portal hypertensive gastropathy [amboss.com]

  […] differences in the pproach to management CAUSES Upper GI Bleeding peptic ulcer disease (75% are gastric, rather than duodenal) Varices (90% are oesophageal, rather than gastric) Oesophagitis Gastritis Duodenitis Mallory-Weiss tears Portal hypertensive gastropathy [lifeinthefastlane.com]

  Other less common causes were erosive gastritis (1.8%), Mallory Weiss tear (1.8%), and retch gastropathy (1.1%). Non steroidal anti inflammatory (NSAID) ingestion was reported in 7.56% of cases. Melena was the commonest mode of presentation. [tropicalgastro.com]

  Patients with chronic liver disease and portal hypertension are at an increased risk for variceal hemorrhage and portal gastropathy in addition to ulcer hemorrhage. [emedicine.medscape.com]

  Eine medikamentöse vasoaktive Therapie mit einem Vasopressin-Analogon ist bereits beim Verdacht auf eine akute Blutung aus Varizen oder im Rahmen einer portal-hypertensiven Gastropathie indiziert. [thieme-connect.com]

• Black Stools

  Tarry black stools indicate a bleeding source in the upper GI tract; bright red blood from the rectum usually indicates bleeding in the distal colon. GI bleeding is treated as a potential emergency. [medical-dictionary.thefreedictionary.com]

  Although not all black stools represent melena, patients who report black stools are much more likely to have a UGIB source. The physician should inspect a stool sample when the patient has a GIB. [jamaevidence.mhmedical.com]

  stools on per rectal examination. coagulation profile – primary or secondary clotting defectsRBC morphology – hypochomic, microcytic anemia, chronic blood loss Protect airway and give high-flow oxygenInsert 2 large-bore (14-16G) IV cannulate take blood [slideshare.net]

  Examples of colors of stools and the causes include: Black, tarry, sticky stools: Gastritis (bleeding from the stomach) Black stools (no odor, not sticky): Medications like iron pills or bismuth-containing medications (Pepto-Bismol) Yellow stools: Celiac [emedicinehealth.com]

• Hypotension

  Tachycardia and Orthostatic Hypotension. There have been discussions in the literature about other findings to rule in/out upper GI bleeding. [mdedge.com]

  Rembacken Dealing with upper gastrointestinal (UGI) bleeding is fraught with pitfalls, not least because spotting those patients who are suffering significant bleeding can be difficult amongst the majority of referrals who are ill and hypotensive for [ueg.eu]

  […] active hemorrhage (flat ulcer base) 5% of cases Clinical features Clinical features of gastrointestinal bleeding UGIB LGIB Symptoms Anemia due to chronic blood loss Acute hemorrhage: signs of circulatory insufficiency or hypovolemic shock Tachycardia Hypotension [amboss.com]

  - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of [slideshare.net]

  Circulation Assessment Observations Heart rate – tachycardia can be an early sign of volume depletion Blood pressure – hypotension doesn’t typically occur until there has been significant blood loss (1500-2000mls), so if hypotension is present this is [geekymedics.com]

• Tachycardia

  A nasogastric lavage with red blood (summary LR, 3.1; 95% CI, 1.2-14.0), tachycardia (LR, 4.9; 95% CI, 3.2-7.6), or a hemoglobin level of less than 8 g/dL (LR range, 4.5-6.2) increase the likelihood of a severe UGIB requiring urgent intervention. [ncbi.nlm.nih.gov]

  Patients with lesser degrees of bleeding may simply have mild tachycardia (heart rate > 100) or no signs at all. [msdmanuals.com]

  Lesion without active hemorrhage (flat ulcer base) 5% of cases Clinical features Clinical features of gastrointestinal bleeding UGIB LGIB Symptoms Anemia due to chronic blood loss Acute hemorrhage: signs of circulatory insufficiency or hypovolemic shock Tachycardia [amboss.com]

• Orthostatic Hypotension

  Tachycardia and Orthostatic Hypotension. There have been discussions in the literature about other findings to rule in/out upper GI bleeding. [mdedge.com]

  Lancet 2009;373:42-7. [ Reference ] Management Medical therapy Resuscitation, ABC including look for orthostatic hypotension etc. Consider transfusion for shock or acute fall in Hb below 7.0 g/dL (below 10.0 if IHD, PVD etc). [lifeinthefastlane.com]

  If bleeding is severe, patients may be hypotensive or tachycardic, or may exhibit orthostatic hypotension. Physical examination should assess for guarding, rebound tenderness, prior surgical scars, and sequelae of chronic liver disease. [aafp.org]

• Flushing

  An enema involves flushing water or laxative into the rectum using a special squirt bottle. For the test, the patient will lie on a table while the radiologist inserts a flexible tube into the patient’s anus. [web.archive.org]

• Oliguria

  General examination focuses on vital signs and other indicators of shock or hypovolemia (eg, tachycardia, tachypnea, pallor, diaphoresis, oliguria, confusion) and anemia (eg, pallor, diaphoresis). [msdmanuals.com]

  Two days after admission, we initiated hemodialysis for persistent oliguria and progression of dyspnea. Following this, he received regular hemodialysis and antibiotics. [ncbi.nlm.nih.gov]

  Bloody nasogastric aspirate indicates active upper GI bleeding, but about 10% of patients have no blood in the nasogastric aspirate. 4 Then the focus should be on vital signs and any indication for hypovolemia (e.g., tachycardia, tachypnea, oliguria, [uspharmacist.com]

Extensive workup revealed multiple diverticula in the small and large intestines without identification of any source of active bleeding in either patient. Laparoscopic exploration of the abdominal cavity was performed. [ncbi.nlm.nih.gov]

Etiology Although lower GI bleeding can occur at any age, specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup 2,6 : adolescents and young adults inflammatory bowel disease [radiopaedia.org]

(See Clinical Presentation and Workup, below.) Peptic ulcer disease and UGIB Peptic ulcer disease (PUD) remains the most common cause of UGIB. [emedicine.medscape.com]

Advantages of MDCT for the diagnostic workup of patients with suspected acute abdominal hemorrhage include widespread availability, speed, reproducibility and minimal invasiveness. [doi.org]

In general, surgery for obscure GI bleeding is indicated for patients who continue to bleed and have had negative endoscopic and radiologic workups, and who are clearly operative candidates. [acphospitalist.org]

• Gastric Varices

  Convert to ICD-10-CM : 578.9 converts directly to: 2015/16 ICD-10-CM K92.2 Gastrointestinal hemorrhage, unspecified Approximate Synonyms Bleeding gastric varices Gastric varices bleeding Gastric varices, bleeding Gastrointestinal hemorrhage GI hemorrhage [icd9data.com]

  It was highest for upper GI malignancies (95%) and varices (52%; particularly gastric varices, 70%) aetiologies. [journals.plos.org]

  Gastric varices: Endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with UGIB from gastric varices. [patient.info]

• Hemoglobin Decreased

  Day six of hospitalization, he began having maroon stools, his hemoglobin decreased to 8.1 g/dL and his platelets to 81 × 1000/mcL. On day seven, the hemoglobin decreased to 6.4 mg/dL. [ncbi.nlm.nih.gov]

• Microcytic Anemia

  anemia, chronic blood loss Protect airway and give high-flow oxygenInsert 2 large-bore (14-16G) IV cannulate take blood for FBC, U&E, LFT, clotting, cross-match 4-6 units (1 unit per g/dL < 14g/dL)Give IV colloid while waiting for blood to be crossmatched [slideshare.net]

Of these, 1114 were randomised to PPI treatment and 1109 to control treatment. [doi.org]

Treatment Eating, Diet, & Nutrition Clinical Trials Constipation Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Constipation in Children Definition & Facts Symptoms & Causes Diagnosis Treatment Eating [niddk.nih.gov]

The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77). [ncbi.nlm.nih.gov]

Given all of these initial difficulties, the prognosis is sometimes just a guess. Bleeding that initially seems inconsequential may rapidly become deadly. [web.archive.org]

Shock: the presence of signs of shock at presentation confers a worse prognosis. [patient.info]

Almost nothing has been reported on longer term prognosis following upper GI bleeding. [journals.plos.org]

The demographics of the affected individual will depend on the underlying etiology (see below). Classically presents with hematemesis and/or melena. [radiopaedia.org]

The etiologies, which include NSAID use, are similar to those mentioned in the above discussion of gastritis. [emedicine.com]

This is in contrast to reports from other parts of India, where variceal bleeding is the predominant etiology. [tropicalgastro.com]

A nationwide study of the incidence and etiology of lower gastrointestinal bleeding. [emedicine.medscape.com]

Etiology and Work-Up Assessment of the etiology of hematochezia begins with ruling out an upper GI source of the bleed; 10% to 15% of patients presenting with hematochezia without hematemesis are ultimately diagnosed with an upper GI etiology. 4,5 BUN-to-Cr [mdedge.com]

Author information 1 Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts. [ncbi.nlm.nih.gov]

Center for Clinical Epidemiology & Evidence‐Based Medicine, Second Military Medical University, Shanghai, China. Search for more papers by this author J.‐F. [doi.org]

This Review discusses trends in the epidemiology and outcome of gastrointestinal bleeding in elderly patients. [nature.com]

However, from previous studies, the NHIRD is of acceptable quality to provide reasonable estimations for epidemiological data [ 13 – 15 ]. [bmcnephrol.biomedcentral.com]

Card, Epidemiology of Upper Gastrointestinal Bleeding, GI Epidemiology, (172-184), (2014). [dx.doi.org]

For centuries, physicians have used gastrointestinal tubes to study gastrointestinal physiology and pathophysiology. 1 One of the unblemished icons of medicine is the placement of a nasogastric or orogastric tube to examine the gastric contents in patients [jamanetwork.com]

Etiology and pathophysiology Acute upper GI bleeding may originate in the esophagus, stomach, and duodenum. [dx.doi.org]

《World journal of gastrointestinal pathophysiology》 5 (4): 467–78. doi:10.4291/wjgp.v5.i4.467. PMID 25400991. ↑ 가 나 다 라 마 바 Westhoff, John (March 2004). “Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification”. [ko.wikipedia.org]

To our knowledge, no systematic evaluation of MGIB rates from randomised controlled trials (RCTs) of pharmacological stroke prevention in patients with AF has been conducted. [ncbi.nlm.nih.gov]

Summary Various antiplatelet and anticoagulation options are available for stroke prevention in patients with atrial fibrillation (AF). [doi.org]

If this is sufficient then beta blockers and nitrates may be used for the prevention of re-bleeding. [en.wikipedia.org]

Patients may require transfusions, fluid replacement, endoscopic treatment, or gastric lavage and are watched carefully so as to prevent shock and hypovolemia. In all patients blood loss is evaluated and ability to coagulate is tested. [medical-dictionary.thefreedictionary.com]