BLEEDING STOMACH

Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage (loss of blood) in the gastrointestinal tract, from the pharynx to the rectum. It has diverse causes, and a medical history, as well as physical examination, generally distinguishes between the main forms. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding. Initial emphasis is on resuscitation by infusion of intravenous fluids and blood transfusion. Treatment with proton pump inhibitors, octreotide, and antibiotics may be considered in certain cases. Upper endoscopy or colonoscopy are generally considered appropriate to identify the source of bleeding and carry out treatment. Signs and symptoms[edit] Gastrointestinal bleeding can range from microscopic bleeding, where the amount of blood is such that it can only be detected by laboratory testing, to massive bleeding where bright red blood is passed and hypovolemia and shock may develop. Blood that is digested may appear black rather than red, resulting in "coffee ground" vomitus or stool.[1] Differential diagnosis[edit] Gastrointestinal bleeding can be roughly divided into two clinical syndromes: upper gastrointestinal bleeding and lower gastrointestinal bleeding.[1] Types of causes include: infections, cancers, vascular disorders, adverse effects of medications, and blood clotting disorders.[1] Upper gastrointestinal[edit] Main article: Upper gastrointestinal bleeding Upper gastrointestinal bleeding is from a source between the pharynx and the ligament of Treitz. An upper source is characterised by hematemesis (vomiting up blood) and melena (tarry stool containing altered blood). About half of cases are due to peptic ulcer disease.[2] Esophagitis and erosive disease is the next most common causes.[2] In those with liver cirrhosis 50–60% of bleeding is due to esophageal varices.[2] Approximately half of those with peptic ulcers have an H. pylori infection.[2] Other causes include: gastric or duodenal ulcers, Mallory-Weiss tears, cancer, and angiodysplasia.[1] A number of medications are found to cause upper GI bleeds.[3] NSAIDs or COX-2 inhibitors increase the risk about fourfold.[3] SSRIs, corticosteroids, and anticoagulants may also increase the risk.[3] The risk with dabigatran is 30% greater than that with warfarin.[4]