Gastrointestinal bleeding indicates underlying pathology in either the upper or lower gastrointestinal (GI) tract. Hematemesis (vomiting red blood or “coffee-ground” material) and melena (black, tarry stool) usually indicate upper GI bleeding proximal to the suspensory ligament of the duodenum, also called the ligament of Treitz. Peptic ulcer disease (PUD) is the most common cause of upper GI bleeding. Hematochezia (red blood in the stool) is most often associated with lower GI bleeding (although it infrequently occurs with massive upper GI bleeding that is typically associated with hypotension). Lower GI bleeding can be from diverticular disease, angiodysplasia, polyps or tumors, inflammatory bowel disease, or internal hemorrhoids. Diagnosis is made by clinical history and physical exam, followed by upper and/or lower GI endoscopy. The source of the bleeding can usually be identified and treated with endoscopy.
Last updated: Feb 28, 2023
Upper gastrointestinal bleed (proximal to the ligament of Treitz):
Lower GIB (distal to the ligament of Treitz):
Diagnosis and management of GIB tend to go hand-in-hand and will vary depending on the hemodynamic stability of the patient.
Assess the patient’s hemodynamics Hemodynamics The movement and the forces involved in the movement of the blood through the cardiovascular system. Vascular Resistance, Flow, and Mean Arterial Pressure and stabilize:
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