Gastrointestinal Hemorrhage
Introduction
Gastrointestinal bleeding is a medical emergency condition characterized by heavy bleeding of the upper part of the digestive system, the oesophagus, the stomach or the small intestines. The condition is more common in elders and people with other medical conditions such as liver condition and blood clotting disorders. The symptom differs depending on the cause and the site of the bleeder. Various diagnostic procedures are done to confirm the diagnosis and confirm so that one can arrest the bleeding and to treat the condition leading to haemorrhage. It is a potential life-threatening abdominal condition that calls for an emergency medical condition which is a common cause of hospitalization
Pathophysiology of Gastrointestinal Bleeding
The diagnostic procedure is done to distinguish if it is lower gastrointestinal bleeding or upper gastrointestinal bleeding. Upper gastrointestinal are more common compared to the lower GI bleeding (Kim et al., 2014). The aetiology of upper gastrointestinal bleeding is as follows.
- Peptic ulcer disease. Both gastric and duodenal ulcers are the most common causes of upper gastric bleeding. Peptic ulcers may be as a result of colonization by bacteria such as (Kim et al., 2014) Helicobacter pylori and chronic use of aspirin as well as other non- steroidal anti-inflammatory drugs such as ibuprofen.
- Stress ulcers. These acute gastroduodenal lesions result from episodes of shock, sepsis, surgery, and burns, among others. Curling ulcers occur after injuries while Cushing’s ulcer occurs as a result of hormones action following an intracranial process.
- Oesophagal and gastric varices. These are dilated veins that result from portal hypertension. Therefore variceal haemorrhage is precipitated by an injury on varix due to oesophagal reflux or increased pressure causing bleeding.
- Other conditions that lead to gastric haemorrhage are erosive inflammation of gastric mucosa (erosive gastritis), Mallory Weiss syndrome, caused by partial thickness mucosal tear due to severe retching, and reflux esophagitis (Kim et al., 2014).
The lower gastrointestinal bleeding is caused by colonic bleeding, rectal and anal bleeding. Colonic bleeding is the most common form of lower gastrointestinal bleeding. Lower gastric bleeding may be caused by neoplastic bleeding, polyps, ulcerative colitis, and infectious diarrhoea, among others. Gralnek et al. (2017) acknowledge that small bowel bleeding is caused by Meckel’s diverticulum, neoplasm, mesenteric ischemia, intestinal varices, and enteric infection, among others. Rectal and anal bleeding is caused by proctitis, haemorrhoids, and anal fissures.
Clinical Presentation
Gastrointestinal bleeding present with various signs and symptoms such as bright red blood in vomit, vomit that looks like the coffee ground, black and tarry stool, and dark blood mixed with stool. According to Ghosh Watts & Kinnear, (2015), bleeding occurs in the lower digestive tract is characterized by signs and symptoms such as black or tarry stool, melena or the dark blood mixed with stool. Stool mixed or coated by bright red blood (hematochezia) to show active gastric bleeding.
Treatment and Justification
Pharmacotherapy approach options are aimed to achieve hemostasis in gastrointestinal bleeding. Saljoughian, (2016) notes that some of the treatment modalities include antifibrinolytics such as tranexamic acid and epsilon –aminocaproic acid, low doses of octreotide and antiangiogenesis agent. Other than management of bleeding, these drug reduces the risk of formation of a thrombus which would cause an embolism. The acute management procedure aims at arresting of the bleeder, airway management and circulation. Blood transfusion is prescribed in the case where substantial blood loss is registered. Surgical management is done by creating a bypass such as transjugular intrahepatic portosystemic shunt to allow control of the bleeder (Saljoughian, 2016). Finally, treatment of the underlying condition discussed above is the surest way of managing gastrointestinal bleeding. For instance, where bleeding is caused by fissure, surgical suturing can help to reduce bleeding. Blood transfusion and administration of plasma expanders minimizes the risk of hypovolemic shock and maintains the cardiac output.
Conclusion
Various medical emergencies are the leading causes of mortality and comorbidities in society. Therefore, every person has a role in ensuring that they take various preventive modifiable, which are the leading causes of these conditions. One should limit the use of non-steroidal anti-inflammatory drugs, quitting smoking and limiting the use of alcohol. It is also advisable one to attend regular medical checkup to make sure the early signs are detected early.
References
Ghosh, S., Watts, D., & Kinnear, M. (2015). Management of gastrointestinal haemorrhage. The postgraduate medical journal, 78(915), 4-14.
Gralnek, Ian M., Ziv Neeman, and Lisa L. Strate. “Acute lower gastrointestinal bleeding.” New England Journal of Medicine376.11 (2017): 1054-1063.
Kim, B. S. M., Li, B. T., Engel, A., Samra, J. S., Clarke, S., Norton, I. D., & Li, A. E. (2014). Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World journal of gastrointestinal pathophysiology, 5(4), 467.
Saljoughian, M. (2016). Gastrointestinal Bleeding: An Alarming Sign. US Pharm, 12, 17.