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02-04-21 1 Hits

The gastrointestinal bleeding is a common problem that motivates many emergency visits to hospitals.
In addition to the frequency, the mortality of gastrointestinal bleeding is around 5 to 10% of patients, so it is important to attend quickly, evaluate the causes and initiate early treatment to reduce decompensation due to acute blood loss.
Different types of gastrointestinal bleeding
There are a wide variety of causes that can generate digestive tract bleeding, however, it is necessary to distinguish between the different types of gastrointestinal bleeding. Although the current classification is much more complex and detailed, we will mention the most outstanding concepts:
Acute, chronic and occult gastrointestinal bleeding:
• Acute: bleeding occurs quickly and usually with many associated general symptoms.
• Chronic: occurs for a longer time, bleeding is visible, usually in the stools, but with few general symptoms.
• Hidden: it is the bleeding that occurs silently, does not leave symptoms and is only detected by special laboratory tests.
Upper and lower gastrointestinal bleeding:
• Upper gastrointestinal bleeding is that which occurs in the esophagus, stomach, and first segment of the small intestine (duodenum).
• Lower gastrointestinal bleeding is one that originates in the two lower segments of the small intestine, colon and rectum.
It is important to clarify these general concepts since the presentation of the symptoms and the treatment will vary in each case.
Is gastrointestinal bleeding common?
The gastrointestinal bleeding acute is the most frequent cause of hospital admissions in the US, approximately 300,000 / year.
The gastrointestinal bleeding is higher often low, but have a similar mortality rate, about 4 to 10%. It is more common in men and the incidence increases with age.
Causes of gastrointestinal bleeding
• Gastric or duodenal ulcer.
• Gastritis.
• Intake of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, ketoprofen, indomethacin, or aspirin.
• Taking oral anticoagulants.
• Steroid intake.
• Intake of alcoholic beverages in excess.
• Varicose veins in the esophagus or stomach, usually as a consequence of liver cirrhosis, or advanced liver diseases.
• Gastrointestinal cancer, at any level of the digestive tract.
• Vascular injuries.
• Diverticulosis, mainly in the colon.
• Inflammatory bowel disease, such as Crohn's disease.
• Hemorrhoids and pathologies in the anus and rectum.
What are the symptoms of gastrointestinal bleeding?
The symptoms of digestive tract bleeding vary if they are acute or chronic, high or low.
Acute hemorrhages, whether high or low, are accompanied by general symptoms such as:
• General weakness
• Dizziness
• Fainting or acute loss of consciousness.
• Shortness of breath or dyspnea
• Palpitations
• Abdominal cramps
• Accentuated paleness.
• Cold and profuse sweating.
• Drowsiness or confusion
Symptoms also depend on the area and severity of the bleeding.
• Upper gastrointestinal bleeding
• Vomiting with blood (hematemesis), the content of the vomit may be bright red or fresh blood or brown in color (partially digested blood, appearance "like coffee grounds").
• Black stools (melena), product of the digestion of blood that runs through the entire digestive tract, giving rise to black, dark, pasty stools with a very bad smell.

• Low gastrointestinal bleeding
• It does not cause vomiting with blood
• Stools can be:
• Hematochezia: stool mixed with fresh blood;
• Rectorrhagia, expulsion of fresh blood, without stool.
In the case of chronic gastrointestinal bleeding:
General symptoms
• They appear slowly, over the course of days, weeks, or even months. They are progressive symptoms.
• Weakness
• Pale from anemia
• Symptoms of bleeding
• You can see dark or black stools but without causing general symptoms of decompensation due to bleeding, it occurs in the case of mild bleeding, where the loss of blood is slow and progressive, in such a way that the body adapts to the slow loss of blood presented few general symptoms.
• You can also see fresh red blood mixed or not with the stool but in small amounts that do not decompensate the patient
• In the case of hidden gastrointestinal bleeding, the patient is unable to appreciate the leakage or loss of blood by any route. It is detected by stool examinations or in the process of investigating a picture of anemia without apparent cause.
How to treat gastrointestinal bleeding?
1. See a doctor for any suspicious symptoms or for evidence of blood in the stool or vomit.
2. The doctor will investigate the origin of the bleeding and treatment is based on combating the cause.
3. Avoid meals until directed by the specialist. In many cases, emergency endoscopic studies are warranted, which must be performed on an empty stomach.
4. Compensate vital signs and hydration status.
5. Compensate for any electrolyte imbalance or alteration in blood chemistry that may be involved in bleeding.
6. Monitor and improve blood hemoglobin levels. Transfusions should be performed to compensate a patient with severe blood loss.
7. The specialist will perform endoscopic studies of the digestive tract:

• videogastroscopy;
• video colonoscopy;
• videoenteroscopy.
This has a dual purpose:
1. Find the cause of the bleeding.
2. Resolve the bleeding endoscopically if possible.
There are different endoscopic therapies available that quickly improve bleeding in most cases:
• Endoscopic sclerosis or direct injections to bleeding lesions.
• Argon plasma coagulation.
• Endoscopic clips or bands (ligation) with mechanical effect that closes the bleeding vessel.
• Angiographic embolization, which is done without endoscopy, through radiology.

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