Gastrointestinal Bleeding

Gastrointestinal bleeding (GI Bleeding)

  • Not just a gastroduodenal disorder but may occur anywhere along the alimentary tract
  • Is a symptom of an upper or lower GI disorder
  • May be obvious in emesis or stool or it may be occult

Pathophysiology and Etiology

  • Trauma anywhere along the GI tract
  • Erosions of ulcers
  • Rupture of an enlarged vein such as varicosity
  • Inflammation such as esophagitis
  • Alcohol and drugs (NSAIDs, aspirin, corticosteroids)
  • Diverticular disease
  • Cancers
  • Vascular lesions or disorders
  • Anal disorders such as hemorrhoids

Clinical Manifestations

  1. Presence of blood
    • Bright red: vomiting – high in the esophagus; stool – rectum or distal colon
    • Mixed with dark red – higher up in colon and small intestines
    • Shades of black – esophagus, stomach, doudenum
    • Tarry stools – excessive blood in the stomach
  2. Massive bleeding: rapid pulse, hypotension, hypovolemia
  3. Subacute bleeding: weakness, dizziness, intermittent bleeding
  4. Chronic bleeding: intermittent bleeding, increased weakness, paleness, shortness of breath

Diagnostic Evaluation

  1. Complete patient history
  2. CBC and coagulation studies
  3. Endoscopy
  4. Occult blood testing

Management

  1. If due to drugs, discontinue medications
  2. If due to ulcer, diet and lifestyle modification
  3. Therapeutic endoscopic procedures such as cautery
  4. Surgery
  5. Place on NPO, NGT insertion
  6. Initiation of IV lines and oxygen therapy
  7. Administer blood replacements and embolization
  8. Electrocoagulation

Complications

  1. Hemorrhage
  2. Shock
  3. Death

Nursing Management

  1. Maintain NG tube and NPO status
  2. Monitor intake and output accurately
  3. Administer IV fluids and blood products
  4. Observe for signs of shock
  5. Provide comfort
  6. Enhance family coping

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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