Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Gastrointestinal bleeding
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Definition
Bleeding from the gastrointestinal tract (GI) is an important surgical emergency that requires urgent evaluation and assessment if major morbidity and mortality is to be avoided. After initial assessment of haemodynamic status and resuscitation, attention should be drawn to trying to determine the site of bleeding as well as potential comorbidities.
Classification
Upper gastrointestinal haemorrhage is defined as bleeding occurring in the GI tract proximal to the ligament of Treitz (duodenojejunal flexure) whereas lower gastrointestinal haemorrhage is defined as bleeding arising in the bowel distal to this.
History
Patients commonly present with GI bleeding either to the emergency department, or often during hospital admission for another illness. In most cases the history offers the best clue as to the site of potential haemorrhage:
Bleeding: the mode of bleeding (haematemesis versus rectal bleeding), type (bright red, clotted, altered blood/melaena), and quantity of blood and duration of symptoms offer vital clues.Melaena refers to blood that has been partially digested by enzymes rendering it black and ‘tar-like’ in appearance and very foul smelling. Dark clotted blood usually results from a proximal lower GI bleed, but may be confused with melaena. Bright red bleeding usually implies a distal lower GI bleed.Note that a massive upper GI bleed may also present with bright red bleeding although the patient is usually very haemodynamically unstable in this case. Occult bleeding refers to a slow and intermittent pattern of blood loss and does not pose an immediate threat though warrants investigation.
Change in bowel habit: may signify underlying pathology.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 247 - 257Publisher: Cambridge University PressPrint publication year: 2009