Nurse Bob's MICU/CCU Survival Guide

Gastroenterology in Critical Care

Gastrointestinal Bleeding

Gastrointestinal Bleeding

I.  Definition of Gastrointestinal Bleeding

    A. This is any type of bleeding regardless how large or small from the gastrointestinal tract.

    B.  The gastrointestinal tract extends from the pharynx to the rectum.

    C.  Can be microscopic bleeding

        1. The amount of blood is so small that it can only be detected by laboratory testing.

        2.  Can be massive resulting in hypovolemic shock and death.


II. Causes and Detection of Gastrointestinal Bleeding.

    A. Diverse causes.

        1. Physical examination.

        2. Laboratory testing including CBC, Occult blood. to test for slow bleeding.


III.  Gastrointestinal bleeding can be roughly divided into two clinical syndromes.

    A. Upper gastrointestinal bleeding

        1. Occurs from  the pharynx to the ligament of Treitz.

        2. Characterized by hematemesis and melena.

    B. Lower Gastrointestinal bleeding.

        1. Usually seen as red blood per rectum.

        2. Hematemesis may be absent.

        3. Occurs from the proximal stomach to the colon.


IV. Treatment of Gastrointestinal Bleeding

    A. Early emphasis is on Resuscitation.

        1. Fluid Resuscitation

            a. Intravenous fluids

            b. Blood transfusion.

    B. Acid Suppression.

        1. Proton Pump Inhibitors

            a. Reduce gastric acid production.

            b. Enhances healing of bleeding lesions

    C. Reduction of Fibrinolysis

        1.  Tranexamic Acid.

        2.  Attempt to reduce blood product requirements.

    D. Correct Coagulapathy

         1. Prothrombin time.

         2. Vitamin K

         3. Fresh frozen plasma.

    E. Reduce portal pressure.

        1. Vasopressin.

        2. Octreotide.


V. Esophageal Varices

    A. A complication of cirrhosis of the liver.

    B. A Blakemore-Sangstaken Tube may be inserted.

        1. A temporary measure

        2. Mechanically compresses the varices.


VI. EGD - Esophagogastrodudenoscopy.

    A. May identify sources of bleeding.

    B. Patient Should be stabilized first.

    C. During EGD or Colonoscopy

        1. Source of bleeding may be identified

        2. Injection

        3. Sclerotherapy

        4. Electocautery

        5. Vascular clipping

        6. Diagnostic biopsy


   Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J 2002;78:4-14.

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