Gastrointestinal bleeding: bleeding is caused by local injury or by irritants that scratch or ulcerate the lining (mucosa) of the digestive tract. Bleeding in the digestive tract is divided into two groups: bleeding that starts in the upper tract and bleeding that starts in the lower tract. Bleeding from the duodenum upwards is called upper gastrointestinal bleeding.
Anyone may have gastrointestinal bleeding from the stomach or intestines during their lifetime; the condition is more common in people over 40.
Causes of gastrointestinal bleeding: stomach and duodenal ulcers, stomach cancer, leukaemia (blood cancer), oesophageal varices and other blood and blood-vessel disorders of the digestive tract, medicines, benign tumours, infections, haemorrhoids (piles), stress ulcers, bloody diarrhoea, etc. are causes of gastrointestinal bleeding. Note: one of the common causes of gastrointestinal bleeding is the indiscriminate use of non-steroidal anti-inflammatory drugs such as mefenamic acid, diclofenac, ibuprofen (Brufen), piroxicam, etc.
For this reason, these medicines should only be taken on a doctor's advice and in the amount needed.
Clinical signs of upper and lower gastrointestinal bleeding: stomach ache, nausea and vomiting, black and bloody stools, general weakness, palpitations, shock, cold extremities (hands and feet), paleness, low blood pressure, cold and clammy skin, reduced or no urine output, and raised blood urea. Diagnosis: sometimes endoscopy or colonoscopy and bowel X-rays are needed, and sometimes, depending on the cause, vascular imaging (angiography) or other paraclinical tests are done, including biochemistry, electrolytes, clotting tests (INR, PTT, PT) and a CBC with differential (CBC diff).
Treatment: if the bleeding is caused by an ulcer or perforation of the stomach or duodenum, treatment is with intravenous fluids and/or surgery on the bleeding site; if the cause is oesophageal varices, the varicose vessels must be blocked with a device or with medicines; and if there are multiple infections, the infections must be treated. Injections of ranitidine, cimetidine or hyoscine are usually used to reduce stomach acid and the pain it causes, so that we can move on to the main treatment, for example washing out the stomach through a tube, or similar measures.
A blood transfusion is needed in most cases, and sometimes we also have to use oxygen and a urinary catheter to help with treatment and diagnosis.
Care during your hospital stay: depending on your clinical signs, you may be kept NPO (nothing at all by mouth) for a while. Your vital signs will be checked every 15 minutes by the doctor or nurse. Fluids are given through the blood vessels (a drip). A urinary catheter will be inserted if the doctor orders it. An orogastric tube (from the mouth to the stomach) will be inserted to wash out your stomach. The availability of injectable forms of medicines such as pantoprazole in recent years has made it possible to stop further bleeding with medication.
Finally, if the bleeding continues and threatens the patient's life, we can stop it by various methods using endoscopy. Care after gastric endoscopy: because the throat has been numbed and there is a risk of swallowed material entering the lungs, do not eat or drink for at least 2 hours after endoscopy. If you have been given a sedative injection, rest for 2 hours and do not drive for 12 hours.
- If your doctor recommends medication, be sure to take the medicines as instructed and at the set times.
Care after discharge and nutritional care
- Avoid foods that irritate the stomach. Drink 6 to 8 glasses of water a day.
- Cut alcoholic drinks, coffee and chocolate out of your diet.
- Proteins such as fish, chicken and red meat are suitable.
- Avoid stress. Exercise such as yoga and swimming can play an important part in controlling your stress. Source: Brunner and Suddarth, 2022