The Digestive System|
bleeding is conveniently classified into upper
(encompassing oesophagus, stomach and duodenum) and lower (small and large bowel) gastrointestinal bleeding, which
have different causes but similar clinical features.
The common causes of upper gastrointestinal bleeding are:
and duodenal ulcer
erosions in the stomach in acute gastritis (as discussed earlier)
of the oesophagus (such as in liver cirrhosis); usually bleeding is sudden and
massive (discussed later)
and gastric carcinoma
syndrome which refers to mucosal lacerations (tears) in the distal oesophagus
and proximal stomach that occur during excessive and regular vomiting, retching
or hiccupping; it frequently develops in chronic alcoholics but is may be found
in bulimics as well
The usual causes of lower gastrointestinal bleeding are:
of the small intestine or colon
disease of the colon (diverticulosis)
is characterised by pouchings of the colon mucosa through the muscle layer which
are especially common in the descending colon and sigmoid. As a result of stasis
of faecal material diverticula may become inflamed (diverticulitis). It appears that the diverticula form as a result of
increased intracolonic pressure, and dietary factors may be partly responsible
(diet of low residue) since the condition is rare in developing countries (diet
rich in vegetables) and more common in Western countries (processed food). Many
people who develop diverticulosis are asymptomatic and experience no
complications. Others may complain of mild to moderate intermittent pain
frequently colicky in character or discomfort in the left lower abdomina
quadrant (sigmoid in the most common site), sometimes with local tenderness.
About 15% of people with diverticulosis will eventually develop acute
diverticulitis, when there is more severe pain, tenderness on palpation and
guarding, and this can subside spontaneously or proceed to perforation and
peritonitis. Changes in bowel habit are common, with constipation alone or with
intermittent episodes of diarrhoea. Mild bleeding is a very important sign,
although in most cases blood is not visible in faeces on inspection.
of the colon (dilation and tortuosity of the submucosal veins in the colon
resulting from venous obstruction), which is a degenerative process occurring
usually over the age of 65 and mostly affecting the right colon.
bowel disease (Crohn’s disease and ulcerative colitis)
colitis (bacterial or parasitic)
Haemorrhoids (dilations of rectal submucosal veins that may undergo thrombosis and inflammation; haemorrhoids are idiopathic in most patients while certain precipitating factors have also been identified such as pregnancy, obesity, ascites, constipation and straining, heart failure)
Clinical features: < BACK TO TOP >
gastrointestinal haemorrhage is recognised by haematemesis
(vomiting of blood) and/or melaena
(passage of altered blood in the stools, which is tarry and sticky with a
colour of vomited blood depends on the amount of hydrochloric acid in the
stomach and the duration of its contact with the blood. Thus, if vomiting
occurs shortly after the onset of bleeding, the vomitus appears red, and later
the appearance will be dark red, brown or black. Precipitated blood clots and
acid-degraded blood in the vomitus will produce a characteristic ‘coffee
grounds?appearance when vomited.
in the gastrointestinal tract causes irritation and increased motility, and in
severe bleeding gastrointestinal transit may be so rapid that the blood in the
rectum is bright red (not degraded to be black and sticky).
bleeding from the small intestine or right colon the blood may appear in form
of melaena, or dark red to brown, while bleeding from the sigmoid or rectum
usually presents as fresh blood
(sometimes coating the formed stools). In cases of lower gastrointestinal
bleeding (mainly from small intestine) blackish stool may be due to degradation of the haemoglobin in the colon
by bacteria to haematin or other pigments.
symptoms vary according to the severity of the bleeding; blood loss of less
than 500 mL is rarely associated with systemic signs and symptoms.
serious blood loos symptoms and signs of hypovolaemia (reduced total blood in
the circulation) can occur such as low blood pressure (hypotension), increased
heart rate (tachycardia), pale skin, sweating, weakness, fainting.
Any gastrointestinal bleeding may present only as iron deficiency anaemia due to unnoticed chronic loss of small amounts of the blood; this is called occult bleeding, and if detected warrants further investigation (may be linked to a malignant process, especially in the middle aged and elderly).
Diagnosis: < BACK TO TOP >
examination and blood tests are done to assess the severity of blood loss.
cases of upper gastrointestinal bleeding, urgent endoscopy is necessary to
determine the source of the bleeding.
bleeding status is ascertained by passage of a nasogastric tube, which should
be aspirated at half hourly intervals and the quantity and type of aspirate
lower gastrointestinal bleeding, rectal examination and sigmoidoscopy will
detect most causes of bleeding from the ano-rectal region.
blood is coming from above the rectum, colonoscopy is the investigation of
the site of bleeding can be detected by radionuclide scanning after infusion
red cells (technetium is a radioactive isotope); accumulation of
radioactivity in the form of an expanding patch in an area of the
gastrointestinal system is detected by a gamma camera and indicates active
If bleeding continues, angiography of the superior and inferior mesenteric arteries can be performed to identify leakage of contrast material into the gut on X-ray, thus identifying the site of haemorrhage.
Management < BACK TO TOP >
necessary, blood replacement by transfusion must be done (usually if the
patient is clinically shocked, the pulse rate is consistently >100/minute,
and blood pressure is <100 mm Hg and haemoglobin is <100 g/L).
management depends on the site and cause of bleeding; sometimes bleeding will
stop spontaneously without any treatment.
methods are today preferred over surgery since they are much less invasive,
and they include electrocoagulation, injection of sclerosant materials and
laser energy applied to a bleeding lesion under endoscopic vision.
from oesophageal varices can be treated by balloon tamponade with special a
tube placed into the oesophagus; the inflated balloon compresses the bleeding
blood vessels and stops bleeding. At the same time, gastric contents can be
aspirated through the tube to assess the effectiveness of haemostasis (if
there is no more blood in the stomach, the bleeding has stopped).
If these techniques can not be used, surgery is performed (e.g., excision of the bleeding gastric ulcer, suture of the duodenal ulcer, or resection of the appropriate segment of the colon).
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Gastrointestinal Bleeding :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Gastrointestinal Bleeding :-
(source : -)
7 April 2010
10 December 2004 - International Human Rights Day
World No-Tobacco Day
World Health Day
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails