presentation

1. GI Bleeding
By
Mr Mohamed Atta Amer
Nursing Student

2. • Definition
• Anatomy
• Types
• Causes
• Sign and symptoms
• Risk factors
• Complication
• Diagnosis
• Medical management
• Nursing management
• prevention
Outlines :

3. Definition :
• also known as gastrointestinal hemorrhage , is all forms of bleeding
in the gastrointestinal tract, from the mouth to the rectum.
• Esophagus
• Stomach
• Small intestine, including the duodenum
• Large intestine or colon
• Rectum
• Anus
GI bleeding can occur in any of these organs. If the bleeding occurs in
esophagus, stomach, or initial part of the small intestine
(duodenum), it’s considered upper GI bleeding. Bleeding in the
lower small intestine, large intestine, rectum, or anus is called lower
GI bleeding.

4. Anatomy of GI :
• Individual components of the gastrointestinal system :
• Oral cavity :
The oral cavity or mouth is responsible for the intake of food, and it
is consists of :
- tongue and hard palate
- mucosa : absorption of small molecules such as glucose and
water.
food passes through the pharynx and oesophagus via the action of
swallowing.

5. Anatomy of GI cont. :
• Salivary glands :
Three pairs of salivary glands communicate with the oral cavity.
- Parotids : Immunoglobins are secreted help to fight microorganisms
and a-amylase proteins start to break down complex carbohydrates.
- Submandibular :
secretes 70% of the saliva in the
mouse.
- Sublingual :
provide buffers and lubrication.

6. Anatomy of GIT cont. :
• Stomach :
is a J shaped expanded bag, located just left of the midline
between the oesophagus and small intestine, divided into four
main regions and has two borders called the greater and lesser
curvatures.
• This is where most gastric glands are located and where most
mixing of the food occurs.
• Gastric contents are expelled into the proximal duodenum via
the pyloric sphincter. The inner surface of the stomach is
contracted into numerous longitudinal folds called rugae. These
allow the stomach to stretch and expand when food enters. The
stomach can hold up to 1.5 litres of material.

7. Anatomy of GIT cont.
∗ Small intestine : composed of the duodenum, jejunum, and
ileum.
∗ The duodenum is the proximal C-shaped section that curves
around the head of the pancreas.
∗ The duodenum serves a mixing function as it combines digestive
secretions from the pancreas and liver with the contents
expelled from the stomach.
∗ The start of the jejunum is marked by a sharp bend, the
duodenojejunal flexure.
∗ It is in the jejunum where the majority of digestion and
absorption occurs.
∗ The final portion, the ileum, is the longest segment and empties
into the caecum at the ileocaecal junction.

8. Anatomy of GI cont.
• Large intestine :
consists of the appendix, caecum, ascending, transverse,
descending and sigmoid colon, and the rectum. It has a length of
approximately 1.5m and a width of 7.5cm.
The functions of the large intestine:
- The accumulation of unabsorbed material to form faeces.
- Some digestion by bacteria. The bacteria are responsible for the
formation of intestinal gas.
- Reabsorption of water, salts, sugar and vitamins.

9. Anatomy of GI cont.
∗ Liver : situated in the right upper quadrant of the abdomen. It is
surrounded by a strong capsule and divided into four lobes
namely the right, left, caudate and quadrate lobes.
∗ It acts as a mechanical filter by filtering blood that travels from
the intestinal system.
∗ It detoxifies several metabolites including the breakdown of
bilirubin and oestrogen.
∗ its main roles in digestion are in the production of bile and
metabolism of nutrients.
∗ The bile produced by cells of the liver, enters the intestines at
the duodenum. Here, bile salts break down lipids into smaller
particles so there is a greater surface area for digestive enzymes
to act.

10. Anatomy of GIT cont.
• Gall bladder :
The main functions of the gall bladder are storage and
concentration of bile.
• Bile is a thick fluid that contains enzymes to help dissolve fat in
the intestines.
• Bile is produced by the liver but stored in the gallbladder until it is
needed.
• Pancreas : The pancreas secretes fluid rich in carbohydrates and
inactive enzymes.
• These are secreted in an inactive form to prevent digestion of the
pancreas itself. The enzymes become active once they reach the
duodenum triggered by the hormones released by it
( duodenum).

11. Types :
1. Upper Gastrointestinal Bleeding.
- The upper gastrointestinal tract consists of the mouth, pharynx,
esophagus, stomach, and duodenum.[13] The exact demarcation
between the upper and lower tracts is the suspensory muscle of the
duodenum.
• Can be categorized as either variceal or non-variceal. Variceal is
a complication of end stage liver disease. While non variceal
bleeding associated with peptic ulcer disease or other causes of
UGIB.
• UGIT bleeding is 4 times as common as bleeding from lower GIT,
with a higher incidence in male.

12. Cont.
2. Lower Gastrointestinal Bleeding.
• °Lower gastrointestinal bleeding is defined as abnormal
hemorrhage into the lumen of the bowel from a source distal to
the ligament of Treitz.
• °Originates in the portion of GIT further down the digestive
system :
•-small intestine
•-colon
•-rectum
•-anus

13. Causes :
Upper GI bleeding causes :
•Peptic ulcer. This is the most common cause of upper GI bleeding.
Peptic ulcers are sores that develop on the lining of the stomach and
upper portion of the small intestine.
•Tears in the lining of the tube that connects your throat to your
stomach (esophagus). Known as Mallory-Weiss tears, they can cause
a lot of bleeding. These are most common in people who drink
alcohol to excess.
•Abnormal, enlarged veins in the esophagus (esophageal varices).
This condition occurs most often in people with serious liver disease.
•Esophagitis. This inflammation of the esophagus is most commonly
caused by gastroesophageal reflux disease (GERD).

14. Cont.
Lower GI bleeding causes :
-Inflammatory bowel disease.
-Tumors.
-Colon polyps: Small clumps of cells that form on the lining of your
colon can cause bleeding.
-Hemorrhoids : swollen veins in your anus or lower rectum, similar
to varicose veins.
-Anal fissures: small tears in the lining of the anus.
-Proctitis: Inflammation of the lining of the rectum can cause rectal
bleeding.
-Diverticular disease : If one or more of the pouches become
inflamed or infected, it's called diverticulitis.

15. Signs and symptoms :
• Acute bleeding symptoms
• Patient my develop into shock if have acute bleeding. Acute
bleeding is an emergency condition. Symptoms of shock include :
• a drop in blood pressure
• little or no urination
• a rapid pulse
• unconsciousness
• Chronic bleeding symptoms
• Patient may develop anemia if he have chronic bleeding.
Symptoms of anemia may include feeling tired and shortness of
breath, which can develop over time.
• Some people may have occult bleeding. Occult bleeding may be a
symptom of inflammation or a disease such as colorectal cancer .
A simple lab test can detect occult blood in your stool.

16. Risk Factors :
∗ Peptic ulcer.
∗ Diabetes mellitus.
∗ Liver disease.
∗ Chronic renal failure.
∗ Smoking.
∗ Alcohol consumption.
∗ Gastroesophageal reflux disease.
∗ Concomitant drugs included oral aspirin.
∗ Anticoagulants including warfarin.

17. Complications :
• A gastrointestinal bleed can cause:
• Shock
• Anemia
• Hypovolemia
• Dehydration and Chest Pain
• Death
• Aspiration from massive upper GI bleed;

18. Diagnosis :
∗ Lab tests : Stool tests - Blood tests.
∗ Gastric lavage :to remove stomach contents to determine the
possible location of GI bleeding.
∗ Endoscopy
∗ Colonoscopy
∗ Flexible sigmoidoscopy
∗ Abdominal CT scan.
∗ Angiogram : is a special kind of x-ray in which a radiologist
threads a catheter through your large arteries.

19. Medical management :
• Endoscopy therapy
• - It is important first to confirm the location of the bleed
before planning endoscopy therapy for a patient with an upper GI
bleed.
• Drug therapies
• Medical therapy for non-variceal bleeding should be examined
separately from that for variceal bleeding.
• Drug therapy for variceal bleeding includes the use of vasoactive
drugs (such as terlipressin), which have little effect on patient
survival but reduce the chance of a bleed recurring.

20. Cont.
• Surgical intervention for non-variceal bleeds :
• Surgery is usually reserved for cases where endoscopic therapy has
been unsuccessful.
• The main reasons for surgical intervention in cases of non-variceal
upper GI bleeding include:
• - Active bleeding - unresponsive to endoscopic therapy;
• - Perfuse bleeding - prevents endoscopic visualization;
• - Continuous re-bleeding - despite technically successful
endoscopic treatment;
• - Patients at low risk of death who have experienced unsuccessful
attempts at endoscopy.

21. Nursing management :
∗ Check for the appearance of vomitus, stool, or drainage.
∗ 2. Monitor vital signs and compare with client’s normal and
previous data; you may take blood pressure in different positions
like when sitting, lying, and standing positions as much as
possible.
∗ 3. Assess client’s physiological response to hemorrhage like
changes in mentation, weakness, apprehension, diaphoresis,
restlessness, and anxiety.
∗ 4. Measure central venous pressure if indicated and available.
∗ 5. Strictly monitor fluid intake and output; measure fluid loss
through emesis, gastric drainage and stools.

22. Cont.
∗ Maintain client on bed rest to prevent vomiting.
∗ Place client in fowler’s position during antacid gavage.
∗ Check for signs of secondary bleeding i.e. nose or gums,
ecchymosis
∗ Resume intake with clear/ bland fluids or as indicated by the
physician; avoid giving dark colored foods.
∗ Administer IV fluids/ volume expanders/ fresh whole
blood/platelet/fresh frozen plasmas indicated.
∗ Insert NGT as indicated by the physician.
∗ Perform gastric lavage with cool saline solution until aspirate is
pinkish in color or if it is clear.

23. Prevention :
To help prevent a GI bleed:
•Limit your use of nonsteroidal anti-inflammatory drugs.
•Limit your use of alcohol.
•Drinking plenty of water
•If patient smoke, must quit.
•If patient have GERD, follow his doctor's instructions for treating it.
•Prevent hemorrhoids by resisting the urge to strain when having a
bowel movement, consuming fiber and using laxatives when
necessary.
•After eating, remain upright for at least an hour to avoid acid reflux.