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
- 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
- Massive bleeding: rapid pulse, hypotension, hypovolemia
- Subacute bleeding: weakness, dizziness, intermittent bleeding
- Chronic bleeding: intermittent bleeding, increased weakness, paleness, shortness of breath
Diagnostic Evaluation
- Complete patient history
- CBC and coagulation studies
- Endoscopy
- Occult blood testing
Management
- If due to drugs, discontinue medications
- If due to ulcer, diet and lifestyle modification
- Therapeutic endoscopic procedures such as cautery
- Surgery
- Place on NPO, NGT insertion
- Initiation of IV lines and oxygen therapy
- Administer blood replacements and embolization
- Electrocoagulation
Complications
- Hemorrhage
- Shock
- Death
Nursing Management
- Maintain NG tube and NPO status
- Monitor intake and output accurately
- Administer IV fluids and blood products
- Observe for signs of shock
- Provide comfort
- 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.
