GASTROINTESTINAL

BLEEDING
DR.IWAN KRISTIAN
DEPT.OF.SURGERY
DR.SOETOMO HOSPITAL/ FACULTY
OFMEDICINE, AIRLANGGA UNIVERSITY
Introduction
GI bleeding : 1-2 % of all hospitalization in USA (
300.000 / year )
Overall mortality : 5 12 %
Upper GI bleeding : 10 %
Lower GI bleeding : < 5 %
Upper GI bleeding : 100 cases / 100.000 population
Acid peptic disease 50 -75 %
60 yrs : 35 45 %
Lower GI bleeding : 20-27 / 100.000 population
24 % of all GI bleeding
Male > female

Chung and Kim. Acute Gastrointestinal bleeding.2003

SEVERITY of bleeding
Major bleeding
Acute blood loss causing hemodynamics of hypovolemia
Sudden passage of large amounts of bloody ,maroon,burgundy
or melenic stool in the absence of hemodynamic compromise.
Hmt < 8 g% from base line or < 30 %.
Tranfusion 4 -6 unit / 24 hours.

Non major bleeding

A chemical test for blood in stool
The passage of hemodinamically insignificant amounts of either
gross blood per rectum or melena

Boley and Kaleya :Schackelfords Surgery of the

alimentary tract ,6 th ed
 Occult GI bleeding :
The most common form of GI bleeding
Chronic or intermittent loss of small amount
of blood of which the patients is unaware.
Manifestation : test + or iron deficiency
anemia
Obscure GI bleeding :
Bleeding that persist or recurs without any
obvious source after endoscopic evaluation

Rockey.Current diagnosis & treatment in

gastroenterology , 2 nd ed.2003
classification

Upper GI bleeding : between upper

oesophagus to lig.Treitz
GE variceal bleeding
Non variceal bleeding
Lower GI bleeding : below lig.Treitz
Small bowel bleeding
Colonic bleeding
Sign and symptom

Bleeding
Hematemesis : vomiting fresh blood
Melanemesis : vomiting coffee-ground
Melena : passage of black stool per rectum
Hematochezia : passage of altered non
black/maroon blood per rectum
Rectal bleeding : passage of fresh blood per
rectum
Sign And Symptom

Systemic effect :
Shock or hypotension
Pallor
Dizziness
Weakness
Anemia
Basic element of the
management of GI bleeding
Causes of acute upper GI
bleeding
Management of GI
bleeding
Prompt patient resuscitation and stabilization
Check vital sign.
Insert 2 large caliber peripheral catheter if needed
Volume replacement
Pass a large bore NGT
Perform rectal examination
Take history
Insert ETT if needed
Management contd

Assessment of onset &severity of bleeding

serial exam : vital sign, Hmt,ECG
Determination of bleeding site, after the patient
stabilized to guide the diagnostic work up.
Determination of the cause of bleeding
Medical history
Physical examination
Management contd

Control of active bleeding

Medical : PPI
Endoscopy : injection ,banding,clipping
Angiography and embolization
surgery
Upper GI bleeding
management
Lower GI bleeding
Aetology of lower GI
bleeding
Actual bleeding sites
in patients with
hematosechia
Colon : 74 %
UGI : 11 %
Small bowel : 9 %
No sites found : 6 %
Freqency of colonic bleeding sites in
patients with severe hematosechia

Colonic diverticulosis : 42 %
Colorectal malignancy : 9%
Ischemic colitis : 9 %
Acute colitis, unknown cause : 9 %
Hemorrhoids : 5 %
Post polypectomy : 4 %
Colonic angiodysplasia : 3 %
Crohs disease : 2 %
Other : 10 %
Unkown : 11 %

Longstreth GF .am J Gastroenterol 1997,92-419

Messmann H,Atlas of colonoscopy.2006
LOWER GI bleeding : management
Endoscopic clipping
Lower GI bleeding : surgical
management