GIbloeding

Gastrointestinal bleeding (GI bleeding) is bleeding from any part of the gastrointestinal tract. It can be overt or occult and is categorized as upper GI bleed (UGIB) or lower GI bleed (LGIB) depending on the site relative to the ligament of Treitz. UGIB typically presents with hematemesis or melena; LGIB with hematochezia or melena if bleeding is slow. Occult GI bleeding may cause iron-deficiency anemia.

Common causes include UGIB from peptic ulcer disease, gastritis, esophagitis, esophageal or gastric varices, Mallory-Weiss tear, NSAID- or anticoagulant-related ulcers, and malignancy. LGIB etiologies include diverticulosis, angiodysplasia, hemorrhoids, inflammatory bowel disease, colorectal cancer, ischemic colitis, and post-polypectomy bleeding.

Assessment starts with stabilization: airway, breathing, circulation, with two IV lines and appropriate fluid resuscitation or transfusion as needed. Key labs are CBC, chemistry, coagulation studies, and type and crossmatch. Risk assessment tools such as the Glasgow-Blatchford score aid UGIB triage. Endoscopy serves diagnostic and therapeutic roles: UGIB is typically evaluated within 24 hours, LGIB after bowel preparation. Additional imaging (CT angiography) or radionuclide scanning can localize ongoing or obscure bleeding when endoscopy is nondiagnostic.

Treatment depends on the cause. UGIB may be treated with acid suppression using proton pump inhibitors; variceal bleeds may require vasoactive medications (for example octreotide) and endoscopic hemostasis. LGIB management often involves colonoscopic hemostasis, angiographic embolization, or surgery for refractory bleeding. Address underlying pathology and correct coagulopathy as indicated.

Prognosis varies with age, comorbidity, and bleeding source. Prevention focuses on risk modification, careful NSAID use with gastroprotection when appropriate, and cancer screening where indicated.