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The Difference between Upper and Lower Gastrointestinal Bleed

The gastrointestinal tract is prone to serious tissue damage caused by trauma and certain GI diseases, which can lead to bleeding. It is a major concern that should not be taken for granted. It requires prompt treatment once diagnosed otherwise this can lead to hypovolemic shock and even death. The bleeding can be chronic or acute.

  • Chronic GI Bleed

Chronic GI bleeding is insidious not unless secondary signs and symptoms of hemorrhage are apparent. An individual who has this may complain of easy fatigability, shortness of breath, dizziness and anemia caused by the bleeding. They may also complain of anorexia and unexplained weight loss.

  • Acute GI Bleed

Acute GI bleeding occurs when there is a sudden and significant blood loss due to bleeding. Often, an individual manifests hematemesis, vomiting of fresh blood or coffee ground vomitus. Blood in stools, which takes on various forms depending on the site of bleeding – it can either be dark colored stools or fresh blood passing through the rectum.

Whether it is a chronic or acute GI bleeding, this condition is life-threatening that requires immediate attention and treatment. It is also important to locate the site of the bleeding and do all measures to stop it.  There are two types gastrointestinal bleeding depending on the site it occurs.

Upper Gastrointestinal Bleed (UGIB)

  • Esophagus

  • Stomach

  • Duodenum (first part of the small intestines)

Lower Gastrointestinal Bleed (LGIB)

  • Small intestines

  • Colon

  • Rectum

  • Anus

C:\Users\ella\Documents\gi-bleeding-anatomy.jpg

Upper and Lower Gastrointestinal Bleed – The Comparison

Characteristics

Upper Gastrointestinal Bleed

Lower Gastrointestinal Bleed

Etiology

  • Esophageal varices or esophagitis

  • Gastric or duodenal ulcer

  • Mallory-Weiss tear (tear in the lower esophagus)

  • Cancer of the stomach

  • Cancer of the esophagus

  • Gastritis

  • Anal Fissures

  • Hemorrhoids

  • Angiodysplasia (vascular malformation)

  • Cancer of the colon

  • Cancer of the anus

  • Colonic polyps

  • Diverticulum or diverticulosis

  • Intussusception

  • Colitis

  • Chronic inflammatory bowel disease

  • Crohn’s disease

  • Anal fissures

Signs and Symptoms

  • Melena or Melenic stools  (black, tarry and foul smelling stools or dark-colored stools)

  • Hematemesis

  1. Red Hematemesis – vomiting of fresh blood

  2. Coffee Ground Hematemesis – vomiting of blood altered by stomach acids and enzymes.

  • Dyspepsia

  • Heartburn or epigastric pain

  • Abdominal pain

  • Dysphagia – difficulty in swallowing

  • Jaundice if bleeding is related to liver diseases

  • Weight loss

  • Syncope and/or Presyncope

  • Pallor

  • Hematochezia – fresh blood in stools may be due to hemorrhoids or anal fissure

  • Bloody diarrhea is typical of Colitis, the inflammation of the colon

  • Febrile episodes

  • Hypovolemic shock or dehydration

  • Abdominal cramps or pain

  • Hypotension

  • Decreased hemoglobin levels

  • Pallor

Diagnostic Procedure

  • EGD (Esophagogastroduodenoscopy)

  • Colonoscopy

Notes:

  • In massive Upper GI hemorrhage, the individual may not only pass out melena but also fresh blood in the stools.

  • Blood is a potent laxative that is why a person with either UGIB or LGIB can also manifest diarrhea.

  • It takes approximately 50-100 ml of blood to cause melena, chances are below the said approximation, the person with GI bleeding may manifest Fecal Occult Blood (FOB) which can only be confirmed through Fecal Occult Blood Test (FOBT)

Final Thought!

Gastrointestinal bleeding is not a disease it is a condition caused by tissue damage of the GI tract. Understanding the cause and specific differences between the signs and symptoms of upper and lower GI bleeding is essential for proper treatment. Negligence of this condition may cause a life, thus once manifested prompt and early medical therapy is very vital.


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References :


[0]http://www.nlm.nih.gov/medlineplus/ency/article/003133.htm

[1]http://emedicine.medscape.com/article/187857-overview

[2]http://emedicine.medscape.com/article/188478-overview

[3]http://www.merckmanuals.com/professional/gastrointestinal_disorders/gi_bleeding/overview_of_gi_bleeding.html

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