Gastrointestinal bleeding

Classification according to ICD-10
K92.2	Gastrointestinal bleeding, unspecified
ICD-10 online (WHO version 2019)

The gastrointestinal bleeding ( GI bleeding , GIB) is an acute or chronic blood loss in the lumen of the digestive tract . Than upper gastrointestinal bleeding is defined as a blood flow, which in its origin digestive tract above the distal duodenum has ( Treitz. Band ), lower gastrointestinal bleeding caused below.

The blood loss can be minor to very significant, so that acute gastrointestinal bleeding may be a medical emergency. A Mild chronic bleeding can go unnoticed for a long time, but often leads to anemia ( anemia ).

Symptoms

Gastrointestinal bleeding can manifest itself in addition to invisible symptoms with various visible symptoms:

• As Hematemesis is called the vomiting of blood (blood vomiting). If the blood has already broken down through contact with stomach acid, the vomit looks dark ("coffee grounds") (hematin breakdown).
• Tar stool ( melena ) occurs when the blood in contact with stomach acid is transported throughout the intestine and excreted through the anus.
• In the case of hematochezia (rectal bleeding), fresh red blood is excreted through the anus.

causes

Upper gastrointestinal bleeding (by frequency):

• Stomach ulcer or duodenal ulcer
• Esophageal varices
• Mallory-Weiss Syndrome or Boerhaave Syndrome
• Dieulafoy ulcer
• Gastric carcinoma or esophageal carcinoma
• Superior mesenteric artery syndrome

lower gastrointestinal bleeding:

• Polyps and tumors of the intestine, e.g. B. Colon cancer
• Chronic inflammatory bowel diseases such as ( Crohn's disease and ulcerative colitis )
• Bleeding of the Meckel's diverticulum
• Diverticulitis
• Inflammation of the intestine due to pathogens, parasites, autoimmune processes or circulatory disorders
• Hemorrhoids , fissures, or fistulas of the anus
• Vascular malformations
• Mesenteric infarction of the gastrointestinal tract

Some of the diseases mentioned can also occur as a result of drug treatment (adverse drug effects), e.g. B. the gastric or duodenal ulcer caused by certain painkillers or antibiotic-induced intestinal inflammation , but also by antidepressants. The risk of bleeding in the upper gastrointestinal tract increases up to 2.5-fold with SSRIs, up to 2.9-fold with SNRIs (serotonin-noradrenaline reuptake inhibitors) and with the combination of SSRIs and non-selective NSAIDs (tNSAIDs ) up to 9.1 times if no stomach protection agent is used. If SSRIs are combined with antiplatelet drugs such as clopidogrel or low-dose ASA, which is not infrequently the case, the risk of upper GI bleeding increases up to 4.7 times.

Diagnosis, classification and therapy

Diagnosis and therapeutic measures are varied and depend on the location, severity and above all the cause of the bleeding. The most important examination method (with the possibility of intervention at the same time) is gastroscopy or colonoscopy .

The bleeding is classified endoscopically according to Forrest:

• Forrest I: Signs of acute bleeding
  • Ia: arterial spurting bleeding
  • Ib: oozing bleeding
• Forrest II: Signs of recent bleeding
  • IIa: lesion with vessel stump
  • IIb: clot-covered lesion
  • IIc: hematin-covered lesion
• Forrest III: lesion without signs of bleeding = no bleeding, but bleeding history (hematemesis, tarry stool)

Treatment of the underlying disease has priority. In the case of very acute, significant bleeding (esophageal varices bleeding, Mallory-Weiss syndrome), emergency hemostasis is the main priority as a life-saving measure.

literature

• Gerd Herold: Internal medicine, a lecture-oriented presentation. Cologne 2005.

Individual evidence

1. ↑ H. Kellner: Antidepressants can also attack the stomach. In: MMW update. Med. No. 51-52 / 2009 (151st year).

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !