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Acute Gastrointestinal Bleeding (GIB) - Coggle Diagram
Acute Gastrointestinal Bleeding (GIB)
Definition and Classification
Acute GIB is a life-threatening condition characterized by bleeding in the gastrointestinal tract.
It is classified into Upper GI Bleeding (UGIB) (originating above the ligament of Treitz) and Lower GI Bleeding (LGIB) (originating below the ligament of Treitz).
Types of Bleeding
Hematemesis: Vomiting blood or "coffee ground" material, usually from UGIB.
Melena: Black, tarry stools indicating digested blood, commonly from UGIB.
Hematochezia: Bright red blood in stool, more often from LGIB but can occur in severe UGIB.
Causes of Upper GI Bleeding (Mnemonic: "GUM BLEEDING")
Gastritis (NSAIDs, alcohol, stress)
Ulcers (H. pylori, NSAIDs)
Mallory-Weiss tear (vomiting-related)
Biliary bleeding (hemobilia from trauma or surgery)
Large varices (portal hypertension)
Esophagitis, esophageal ulcers, neoplasms
Inflammatory bowel disease (Crohn’s disease).
Causes of Lower GI Bleeding (Mnemonic: "DRAIN")
Diverticulosis (painless bleeding)
Radiation proctitis
Arteriovenous malformations
Ischemic colitis, infectious colitis
Neoplasms (chronic blood loss).
Clinical Presentation
Symptoms depend on blood loss severity:
Mild: Fatigue, pallor, anemia.
Moderate: Tachycardia, hypotension, low urine output.
Severe: Shock, syncope, unconsciousness.
UGIB signs: Bright red vomit, coffee-ground emesis, melena.
LGIB signs: Bright red stool, mixed blood in stool.
Risk Factors for Stress-Related GI Bleeding
Hypotension, shock, sepsis, burns, multiple trauma.
Liver failure, renal failure, prolonged ICU stay.
Use of anticoagulants, NSAIDs, steroids.
Diagnostic Studies
History and Physical Exam (NSAID use, alcohol, anticoagulants, past GI bleeds).
Lab tests: CBC, coagulation profile, liver function tests.
Imaging: Endoscopy for UGIB, colonoscopy for LGIB, CT angiography for severe cases.
Initial Management (ABCDE Approach)
Airway: Prevent aspiration, suction ready.
Breathing: Oxygen therapy if needed.
Circulation: IV fluids (large bore catheter), blood transfusion for Hb <8 g/dL.
Drugs: Proton pump inhibitors (IV), octreotide for variceal bleeding, vitamin K for coagulopathy.
Endoscopic or surgical intervention in severe cases.
Endoscopic and Surgical Interventions
Endoscopic: Hemostatic clips, thermal coagulation, epinephrine injection, variceal banding.
Surgical: Vagotomy and antrectomy for severe peptic ulcers, colectomy for severe LGIB.
Radiologic intervention: Embolization in severe cases.
Nursing Care and Monitoring
Prevent aspiration (elevate head of bed).
Hemodynamic monitoring (BP, CVP, urine output).
Monitor for signs of rebleeding (blood in vomit/stool, hypotension).
Prepare for diagnostic procedures (endoscopy, angiography).
Emotional support and patient education (diet, avoiding NSAIDs, alcohol cessation).