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Hematemesis
It is the expulsion of vomit with blood from the upper digestive tract (from the duodenal-jejunal angle to the mouth).
Diagnosis
Blood tests may be used to check your oxygen and iron levels. The tests can also show how well your blood clots.
Endoscopy is a procedure used to examine your upper GI. Your healthcare provider will use a scope (thin, bendable tube with a light on the end). He will move the scope down your throat and into your stomach. He may also take a tissue sample to be tested.
CT or x-ray pictures may show the source of the bleeding. The pictures may show a tear, obstruction, or tumor that is causing you to vomit blood.
An angiogram is done to look for and stop bleeding from an artery. Contrast liquid is injected into an artery and x-rays of your blood flow are taken. Tell a healthcare provider if you have ever had an allergic reaction to contrast liquid.
Treatment
Patient with shock, hypotension, or active bleeding should be closely monitored in ICU setting with continuous monitoring of vital signs and clinical status.Adequate IV access should be obtained, preferably with 2 large bore IV’s. IV fluids should be started to maintain adequate perfusion while awaiting blood products.
Patients found to have peptic ulcer disease should be tested and treated for H. pylori if positive. Treatment should consist of one-week eradication therapy and three weeks’ ulcer healing therapy. Maintenance antisecretory therapy is not needed in non-NSAID ulcers.
Proton pump inhibitors (PPI) should be given intravenously in patients with known major peptic ulcer bleeding, including active bleeding or non-bleeding visible vessel after endoscopic hemostasis to lower the risk of rebleeding. Continuation of PPI can be decided once cause of bleeding is determined.
Antibiotics should be initiated in patients with chronic liver disease who present with acute upper GI bleeding.
Endoscopy may be used to treat the cause of your bleeding. Your healthcare provider may use heat to close a tear. He may clip tissue together so it can heal.
Surgery may be needed if you have severe bleeding or other treatments do not work. Surgery may be used to fix a tear in the lining of your stomach or intestine. You may need surgery to remove an obstruction or a tumor
Pathophysiology
From the pathophysiological point of view, bleeding is caused by injuries that occur in the arteries, veins, or capillaries, causing the blood to leak out of the vessels in greater or lesser amounts.
The most common vascular injuries are caused by rupture, thrombosis, embolism, exulcerations, as well as injuries to the walls of the vessels and vascular neoformations.
Other possible mechanisms are changes in intravascular pressure and changes in the factors involved in blood clotting, which promote bleeding and delay clot formation, even in the face of minor damage that would not normally trigger bleeding in a healthy person.
It is the result of hemorrhagic processes coming from the upper segments of the gastrointestinal tract proximal to the Treitz angle.
The rupture of the vessels is subsequent to the digestive action of the gastric pepsin on the gastric, esophageal or duodenal mucosa.
The backscattering of hydrogen ions by ingestion of substances.
Signs and Symptoms
Symptoms that suggest a person may be bleeding internally include:bowel movements that produce dark, tar-like stools, brown or black vomit
Anorexia and vomiting are the most common associated, but nonspecific, signs.
Weight loss, weakness, dark stool (melena), dehydration, and inactivity are other related signs
Etiology
Injuries to the digestive system, ranging from the mouth to the pylorus, can trigger hematemesis, due to:
• Vascular dysfunctions of the gastrointestinal tract
• Erosion of the lining of the esophagus or stomach
• Intestinal schistosomiasis
• Viral hemorrhagic fever
Hematochezia
Hematochezia is the passage of fresh blood through the anus, usually in or with stools. Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed.
Pathophysiology
In UC, mucin subtypes are decreased, in addition to having fewer tight junctions, however, the mechanism by which it triggers chronic inflammation is still uncertain.
The balance between the regulatory and effector immune response is altered, causing an abnormal response and a greater number of cells called "natural killers" that release IL 13, which has a cytotoxic effect on the epithelium, causing apoptosis and greater permeability of bacteria. Non-pathological diners through it, activating the entire inflammatory cascade triggered by dendritic cells in damage to the mucosa, ulcers of the mucosa and abscesses in the crypts are observed, for which there will be hemorrhage resulting in bloody feces of wine color
Colonic epithelium is protected by a mucous layer which is the first barrier of physical and immunological protection
Diagnosis
Rectoscopy: Indicated when bleeding has manifested with rectal bleeding and there is strong suspicion that the cause is of anorectal origin
Colonoscopy: It is the test of choice in case of rectal bleeding without suspicion of anorectal disease, or in case of hematochezia or melena.
Scintigraphy with marked red blood cells: detect the bleeding point
Selective arteriography: detect bleeding point or diagnose angiodysplasia
Endoscopic capsule: scans the small intestine only, useful only for detecting tumors or diverticula
Etiology
Hemorrhoids, colorectal cancer, crohn's disease, ulcerative colitis, ulceration,fissures, e coli, salmonellosis, peptic ulcer,gastric cancer, colon polyps, diverticulitis, intestinal infection, physical trauma,
Treatment
Treatment depends on the cause and severity of the bleeding. In the event of severe bleeding, the patient should be hospitalized for monitoring and evaluation. If heavy bleeding occurs, you will be monitored in an intensive care unit. Emergency treatment may include a blood transfusion. If the person has removed a lot of blood, they may need urgent treatment, which may include:
Embolization by interventional radiology (a procedure to block blood vessels that may be bleeding).
Medicines to decrease gastric acid.
Fluids through a vein.
Possible surgery if the bleeding does not stop.
Blood transfusions.
Melena
Melena refers to black tarry stools, which usually occurs as a result of upper gastrointestinal bleeding. It has a characteristic tarry colour and offensive smell, and is often difficult to flush away, which is due to the alteration and degradation of blood by intestinal enzymes.
Pathophysiology
The Melena is the result of bleeding from the upper part of the digestive tract, from esophagus, stomach and the first portion of the duodenum, we need about 100 to 200 mL of blood in the upper GI tract to cause melena. This pathology its produced by a digested blood in the stomach, the amino acids of red blood cells is the cause of this odd stools.
Diagnosis
The best way to Melena diagnosis is the physical exam, because we can see the Melena and the people who have this pathology can see the Melena. But it’s important to made another group of exams to see the upper GI bleeding, to treat another pathologies like anemia, shock, hematochezia, malignant neoplasms, peptic ulcer and more. An Upper endoscopy for suspected upper GI bleeding its very helpful. A CBC should be obtained in patients with large-volume or occult blood loss. And patients with more significant bleeding also require coagulation studies.
Surgery may be needed if you have severe bleeding or other treatments do not work. Surgery may be used to fix a tear in the lining of your stomach or intestine. You may need surgery to remove an obstruction or a tumor.
A blood transfusion may be needed if you lose a large amount of blood.
Endoscopy may be used to treat the cause of your bleeding. Your healthcare provider may use heat to close a tear. He or she may clip tissue together so it can heal. Bands may be placed around bleeding varices to help them stop bleeding.
Medicine may be given to reduce the amount of acid your stomach produces. This may help if your melena is caused by an ulcer. You may also need medicine to prevent blood flow to an injury or tear. Your healthcare provider may also make changes to medicines you take if they caused your melena. Examples include NSAIDs and blood thinners. Do not stop taking any medicines without talking to your provider.
Etiology
The cause of lower gastrointestinal bleeding can be grouped into several categories:
Anatomic: (diverticulosis)
Vascular: (Angiodysplasia, Ischemic, Radiation-induced)
Inflammatory: (inflammatory bowel disease, infectious)
Neoplastic
Treatment
The first thing we must do is stabilize the patient if they have hypovolemic shock. Next, we need to treat the etiology to stop the upper GI bleeding. After that, we can use drugs like Drugs like: IV proton pump inhibitor and a synthetic analog of somatostatin (Octreotide) to protect the injured mucous membrane and stop the bleeding. In some cases we can put an IV fluid resuscitation and blood transfusion if needed
Endoscopic injection. Your doctor will inject a liquid near the source of bleeding that will stop the flow of blood.
Angiographic embolization. This technique injects particles into the affected blood vessel.
Endoscopic clips. These can close a bleeding blood vessel or other source of bleeding in the tissue in your GI tract.
Endoscopic intravariceal cyanoacrylate injection. You’ll receive an injection near the affected area that contains a special glue to stop bleeding in enlarged veins in your stomach.
Endoscopic thermal probe. This involves burning the blood vessel or tissue that’s causing an ulcer.
Band ligation. This procedure involves placing small rubber bands around hemorrhoids or swollen veins (esophageal varices) to cut off their blood supply, which will make them dry up and fall off.