Summary
Highlights
The video introduces the topic of gastrointestinal bleeding, focusing on patients presenting to the emergency department. It emphasizes the importance of categorizing bleeding as upper or lower GI and starting with ABCs (airway, breathing, circulation) for initial assessment, particularly focusing on circulation in bleeding scenarios.
Upper GI bleeding originates from the stomach or upper small intestine. Common causes include peptic ulcer disease (ulcers in the stomach or duodenum that erode into blood vessels), erosive gastritis/esophagitis, esophageal varices (enlarged blood vessels in the esophagus, often due to liver disease), and Mallory-Weiss syndrome (small tears in the esophagus from vomiting).
Lower GI bleeding occurs in the more distal small intestine and large intestine. Causes include diverticulosis (bleeding from out-pouchings of the intestinal wall, distinct from diverticulitis), vascular ectasias, ischemic colitis, Meckel's diverticulum, infectious colitis, inflammatory bowel disease (ulcerative colitis, Crohn's disease), hemorrhoids, and, rarely, aortoenteric fistula (a very serious connection between the aorta and bowel wall).
Upper GI bleeding is more common than lower GI bleeding, influenced by factors like H. pylori prevalence. Interestingly, a majority of lower GI bleeds resolve spontaneously without significant intervention, though serious causes like diverticular bleeds and aortoenteric fistulas typically do not. Upper GI bleeds are less likely to resolve on their own compared to lower GI bleeds.
Assessment begins with ABCs and evaluating hemodynamic stability (blood pressure, heart rate, skin condition). Key historical points include the number and amount of bleeding episodes (pictures can be helpful), associated symptoms like pain, lightheadedness, dizziness, or syncope, and medical history (alcohol abuse, liver disease, prior surgeries, peptic ulcer disease).
Important medications to inquire about include NSAIDs (e.g., ibuprofen), glucocorticoids, and anticoagulants (e.g., warfarin, new oral anticoagulants, Plavix), as these can induce or worsen GI bleeding. Dietary factors like consuming beets or foods with red dye can mimic GI bleeding, so patients should be asked about recent food intake.
Other potential sources of blood that can be confused with GI bleeding include nosebleeds (swallowed blood can irritate the stomach), hemoptysis (coughing up blood), dental bleeding (especially after procedures or trauma), external hemorrhoids, anal fissures, and vaginal bleeding (which can be mistaken for rectal bleeding).
Important terms include hematemesis (bright red blood vomit), coffee ground emesis (vomit of dark, partially digested blood), melena (dark, black, tarry, sticky stool due to digested blood from the upper GI tract), and hematochezia (maroon blood mixed with stool, often seen with rapid lower GI bleeds or very rapid upper GI bleeds).