1. Gastrointestinal
Bleeding
By Group F2 subgroup C

2. Contents
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Initial Evaluation ( History & Examination )
Approach to the Patient
Sources
Upper GI Bleeds
Lower GI Bleeds
Management

3. Evaluation (History)
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Hematemesis (coffee grounds vs. bright red)
Hematochezia = Bleeding per rectum
Melena
Pain symptoms
Medications eg. NSAIDs, steroids, Iron…etc
PMHx eg. Peptic ulcer , Alcoholism

4. Evaluation (Examination)
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General examination
Abdominal examination
Rectal examination
Stigma of Cirrhosis
NG Tube findings (upper vs. lower GI source)
Urine output

5. Approach to the patient
• CBC
• Serial Hgb
• Platelets
• Basic metabolic panel (BMP)
• Blood urea nitrogen (BUN)
• Creatinine (Cr)
• Blood type and crossmatch
• Coagulation studies
• Imaging studies

6. Sources of GIT Bleeding
Upper GIT
• Esophagus Varices, Esophagitis
• Stomach ulcer, cancer, Gastritis, varices
• Duodenum ulcer, fistula, AVM
(Arteriovenous malformation)

7. Sources of GIT Bleeding
Lower GIT
• Small Bowel AVM, Crohn’s disease,
Cancer, Meckel’s diverticulum, Vasculitis
• Colon Diverticulosis, AVM, Ischemic gut,
Infectious, IBD, Cancer
• Anal Hemorrhoid, Fissure
• Systemic Coagulopathy

8. Management
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Airway Protection and Oxygen
IV Access central or peripheral (2 sites)
Isotonic saline for volume resuscitation
Blood transfusion indications
• transfusing should be based on hemodynamic status,
not lab value of Hgb.
• cardiac ischemia, dyspnea, low pulse pressure
• ICU admission if Significant bleeding
with hemodynamic instability

9. Thank You!