ACUTE
GASTROINTESTINAL
BLEEDING
DEFINITION
Gastrointestinal (GI) bleeding is a
symptom of many digestive system
disorders, including reflux, ulcers
and cancer. It can occur in any part
of the digestive system (GI tract),
which runs from the mouth to the
anus.
Bleeding can be mild and ongoing
or come on suddenly and be life-
threatening.
Doctors divide GI bleeds into upper
and lower bleeds
UPPER GI BLEEDING
DEFINITION
• Upper gastrointestinal (GI) bleeding refers
to bleeding that occurs anywhere in the
esophagus, the stomach, or the upper part
of the small intestine. It is a symptom of an
underlying disorder, and it can be serious.
• Commonly present with hematemesis,
melena, and hematochezia
INCIDENCE LATEST
In the United States,
gastrointestinal (GI) bleeding is
the most common GI diagnosis
requiring hospitalization; upper
GI bleeding is estimated to
occur in 80 to 150 out of
100,000 people each year, with
an estimated mortality rate of 2%
to 10%.
TYPES OF GI BLEEDING
Acute - Sudden, severe bleeding that’s a sign of a medical
emergency.
Chronic - Bleeding that comes and goes over a long time.
Occult - Bleeding is not visible as it is microscopic, but you can
see signs of GI blood loss (such as low blood counts) on
laboratory testing.
Overt - Visible signs of a GI bleed, including abnormal colors or
substances in your feces (poop). You may also vomit blood.
Obscure - When standard endoscopy testing does not reveal a
source of GI bleeding.
RISK FACTORS
Common risk factors for upper GI
bleeding include;
• Chronic Vomiting
• Alcoholism
• Anticoagulant use
• High-dose nonsteroidal anti-
inflammatory drug use
• Older people
Issues affecting the upper GI area that
can cause bleeding include:
Crohn's disease.
Esophageal varices.
Esophagitis.
Gastritis.
Peptic ulcers. CAUSES
Mallory-Weiss tears
Growths
Hiatal hernia
Signs and symptoms of acute UGIB
include the following:
Hematemesis
Melena
Syncope
Dyspepsia
SIGNS & SYMPTOMS Abdominal pain.
Weakness and fatigue.
Pallor ( Pale skin )
Rapid pulse/ HR, which can
make you feel anxious or like
your heart is fluttering.
Complications of gastrointestinal
bleeding include:
Anemia
Hypovolemia COMPLICATIONS
Shock
DIAGNOSIS
• Blood tests.
• Stool Tests
• Upper endoscopy
• Angiography
• Balloon-assisted enteroscopy
• Imaging tests
TREATMENT AND MANAGEMENT
• Blood Transfusion
• Proton Pump Inhibitors (PPIs): Administer high-dose PPIs (e.g., IV omeprazole or
pantoprazole) to decrease gastric acid secretion, particularly if peptic ulcer disease is
suspected.
• Antibiotics: In cirrhotic patients with variceal bleeding, prophylactic antibiotics (e.g.,
ceftriaxone)
• In cases of ongoing severe bleeding, endoscopy should be performed even sooner.
• Surgery is rarely required but may be considered in cases of persistent bleeding
despite endoscopic interventions, or if the source of bleeding cannot be identified or
treated via endoscopy.
• Stop Smoking
• Monitor stool and vomitus for blood
• Record intake and output (I&O) - Low urine output may
be an early indicator of hypovolemic shock.
• Administer PPIs (e.g., omeprazole, pantoprazole) as
ordered to reduce gastric acid secretion, which aids in
NURSING
ulcer healing and reduces the risk of re-bleeding
INTERVENTION • Provide emotional support: Reassure the patient and
family members, explaining procedures and updates to
reduce anxiety.
• Monitor for re-bleeding
• Educate the patient on medication adherence
• Teach the patient to avoid alcohol, smoking, and
NSAIDs, as they can exacerbate bleeding risks or delay
ulcer healing.
To help prevent a GI bleed:
Limit your use of nonsteroidal anti-inflammatory
drugs.
Limit your use of alcohol.
PREVENTION If you smoke, quit.
If you have GERD, follow your health care team's
instructions for treating it.
Regular monitoring and Follow up
Healthy Diet: Encourage a diet rich in fiber, fruits, and
vegetables, which can promote gut health and
reduce constipation, lowering the risk of hemorrhoids
and diverticulosis (common sources of lower GI
bleeding).
Lower GI bleeding refers to
bleeding that occurs from the
large intestine, "colon." It is
part of the gastrointestinal
tract "GI tract
LOWER GI BLEEDING • It can sometimes be invisible,
in which case it can present as
low blood counts, also known as
anemia.
Lower GI bleeding has an
incidence of 20 to 30 cases
per 100,000 person years and
accounts for 20% of GI bleeds.
It requires admission to the
INCIDENCE LATEST hospital in 20 to 30 per
100,000 patients5 and has a
mortality rate of 4%.
Massive - Massive bleeding usually occurs in
patients older than 65 years with multiple medical
problems, and this bleeding presents as
hematochezia or bright red blood per rectum.
Moderate- can occur at any age and presents as
TYPES hematochezia or melena.
Occult - Bleeding is not visible as it is microscopic,
but you can see signs of GI blood loss (such as low
blood counts) on laboratory testing.
- can present in patients at any age.
NSAID medicines - can cause mucosal injury in
upper, mid- and lower GI tract resulting in bleeding
which can be overt (with melaena) or occult (iron
deficiency)
Lack of timely screening for colon cancer and
polyps
RISK FACTORS Use of alcohol- Drinking too much alcohol can
wreak havoc on the digestive tract. It tears away at
the tissue, causing it to become very sensitive.
Angiodysplasias
Colon polyps
Diverticular disease
Tumors
CAUSES Inflammatory bowel disease (IBD): 2 conditions:
Ulcerative colitis, and Crohn's disease
Hemorrhoids
Anal fissures
Signs and symptoms of acute LGIB include the
following:
Melena
Hematochezia
Low blood counts- decrease in hemoglobin
SIGNS and hematocrit levels, which are indicators of
anemia.
AND Feel tired
SYMPTOMS Dizziness or even faintness when bleeding is
heavy
Abdominal pain- occur due to various underlying
conditions. These conditions lead to irritation,
inflammation, or damage to the lower GI tract.
When symptoms are severe, this is due to heavy
abrupt bleeding, and you can go into shock.
Signs of shock can include:
• Drop in blood pressure
SIGNS • Rapid pulse,
AND • Unconsciousness, or reduced urine volume.
(Oliguria) reduced urine output in the setting of
SYMPTOMS lower GI bleeding is primarily due to the body’s
efforts to conserve blood volume and maintain vital
organ perfusion in response to blood loss.
• Abdominal pain
COMPLICATIONS
• Anemia
• Acute Kidney Injury (AKI) Significant blood loss can reduce
perfusion to the kidneys, leading to acute kidney injury
• Infection In some cases, bleeding can occur due to infection in the
colon, and the associated inflammation can increase the risk of
developing sepsis (a serious, body-wide infection)
• Shock
• Death If untreated or inadequately managed, severe lower GI
bleeding can be fatal due to complications like hypovolemic shock,
multi-organ failure, or profound anemia.
DIAGNOSIS
• Blood tests.
• Stool Tests
• Upper endoscopy
• Colonoscopy
• Flexible sigmoidoscopy
• Angiography
• Balloon-assisted enteroscopy
• Imaging tests
Laboratory Tests
Blood transfusion
increasing fiber intake in the diet
staying hydrated with water
TREATMEANT using moist towelettes or cotton wool instead of dry
AND toilet paper to reduce irritation
taking a sitz bath by sitting in a tub of warm water
MANAGEMENT Hemoclips: Mechanical clips are applied to the
bleeding vessel to stop the flow of blood.
Endoscopic clipping- used widely not only for the
treatment of gastrointestinal bleeding but also for a
variety of other gastrointestinal problems
This is a minimally invasive endoscopic procedure performed during a
colonoscopy, where hemoclips (mechanical clips) are applied to the bleeding
diverticulum to stop the flow of blood.
Endoclip
• Continuous monitoring of the patient’s blood pressure,
heart rate, respiratory rate, oxygen saturation, and level
of consciousness.
NURSING • Assess Bleeding
• Monitor Intake and Output (I&O)
RESPONSIBILITY • Assess Bowel Movements
• Educate the patient on the role of diet
• Provide instructions for home care, including
recognizing signs of rebleeding
•Monitor BP
To help prevent a GI bleed:
Limit your use of nonsteroidal anti-inflammatory
drugs.
Limit your use of alcohol.
PREVENTION If you smoke, quit.
If you have GERD, follow your health care team's
instructions for treating it.
Regular monitoring and Follow up
Healthy Diet: Encourage a diet rich in fiber, fruits, and
vegetables, which can promote gut health and
reduce constipation, lowering the risk of hemorrhoids
and diverticulosis (common sources of lower GI
bleeding).
THANK YOU!!
