Acute Gastrointestinal Bleeding 1

Diagnostic characteristics of upper Gastrointestinal Bleeding:

A-Hematemesis:

Hematemesis (excluding hemoptysis or swallowed blood from epistaxis) is observed. blood or material in the nasogastric lavage tests positive for blood. the aspirate will be negative in approximately 10% of patients with a duodenal source of GI hemorrhage. A duodenal source can not be excluded unless gastric lavage contents reveal bile, even if bile is returned the bleeding may have resolved spontenously prior to arrival.

B-MELENA AND HEMATOCHEZIA:

Melena is usually due to bleeding from an upper GI source. hematochezia from an upper source usually indicates severe hemorrhage and corresponds with significant increases in mortality, need for transfusion applications and need for surgery.

C-ABSENCE OF BLEEDING:

If nasogastric lavage reveals bile and no blood then active bleeding from an upper GI source is less likely between 80% and 85% of bleeding resolves spontanously prior to the patient`s arrival then in otherwise stable patients, close follow-up with an endoscopist should be arranged.

Diagnostic characteristics of lower Gastrointestinal Bleeding:

A-HEMATOCHEZIA:

An upper GI source is found for suspected lower GI bleeding in up to 15% of patients presenting with hematochezia. in these instances consider aortoentenc fistula (in patients with abdominal aortic aneurysm repair) or duodenal ulcer. otherwise, bleeding distal to the ligament of Treitz is usually associated with hematochezia.