What is the pathophysiology of GI bleeding?
Etiology and pathophysiology Acute upper GI bleeding may originate in the esophagus, stomach, and duodenum. Upper GI bleeding can be categorized based upon anatomic and pathophysiologic factors: ulcerative, vascular, traumatic, iatrogenic, tumors, portal hypertension.
Can medication cause a GI bleed?
Drugs that can lead to gastrointestinal bleeding include non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ibuprofen, platelet inhibitors such as acetylsalicylic acid (ASS), clopidogrel and prasugrel, as well as anticoagulants like vitamin-K antagonists, heparin or direct oral anticoagulants (DOAKs).
What factors can contribute to a GI bleed?
Causes can include:
- Diverticular disease. This involves the development of small, bulging pouches in the digestive tract (diverticulosis).
- Inflammatory bowel disease (IBD).
- Tumors.
- Colon polyps.
- Hemorrhoids.
- Anal fissures.
- Proctitis.
What medications are used for GI bleeding?
If you have an upper GI bleed, you might be given an IV drug known as a proton pump inhibitor (PPI) to suppress stomach acid production. Once the source of the bleeding is identified, your doctor will determine whether you need to continue taking a PPI .
How do steroids cause GI bleeding?
GI bleeding and perforation are assumed to occur when ulcers erode into underlying vessels. The mechanism by which corticosteroids might induce GI bleeding or perforation has not been fully established, but corticosteroids may impair tissue repair, thus leading to delayed wound healing.
How do Nsaids stop stomach bleeding?
Drugs that reduce stomach irritation include misoprostol (Cytotec), or a proton pump inhibitor such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), or rabeprazole (Aciphex). These drugs can considerably reduce your risk of an ulcer and internal bleeding.
Can pills cause internal bleeding?
Internal bleeding in the gastrointestinal tract may be caused as a side effect of medications (most often from nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin) and alcohol.
Why do we give antibiotics in GI bleed?
Antibiotics should be used for prophylaxis in hospitalized patients with cirrhosis and upper gastrointestinal bleeding. (Strength of Recommendation: A, based on consistent results from two meta-analyses and a cohort study.) Prophylaxis reduces all-cause mortality by 21%, as well as bacterial infections and rebleeding.
Why do you give antibiotics for GI bleed?
Guidelines of major GI societies adopt the use of antibiotics in acute variceal bleeding due to its efficacy in the reduction of bacteremia and spontaneous bacterial peritonitis.
How do NSAIDs cause GI bleeding?
By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers, but the increased risk of ulcers still exists.
How does aspirin cause GI bleeding?
In addition to lowering the blood’s ability to clot, aspirin also inhibits helpful substances that protect the stomach’s delicate lining, creating a “double whammy” effect. As a result, stomach upset or bleeding in the stomach and intestines can occur.
Why does ibuprofen cause GI issues?
It reduces stomach acid and increases mucus production. When ibuprofen is taken in large doses or for a long time, less prostaglandin is produced. This can increase stomach acid and irritate the stomach lining, causing problems.
How does NSAIDs affect the GI tract?
While NSAIDs are effective medications with relatively few risks when taken occasionally, they can affect the gastrointestinal tract in long-term users, resulting in complications such as dyspepsia, which can range from mild to severe, and ulcers, which can cause bleeding, perforation, and obstruction.
How do NSAIDs cause ulcers pathophysiology?
The pathogenesis of symptomatic peptic ulcer disease caused by repeated exposure to NSAIDs is mainly a consequence of systemic (post-absorptive) inhibition of gastrointestinal mucosal cyclo-oxygenase (COX) activity.
Does ibuprofen cause stomach bleeding?
NSAIDs such as ibuprofen may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death.
Can aspirin cause GI bleeding?
Regular aspirin use is associated with gastrointestinal bleeding. Risk appears more strongly related to dose than duration of aspirin use. Efforts to minimize adverse effects of aspirin therapy should emphasize using the lowest effective dose among both short-term and long-term users.
Why does GI bleed increase urea?
When upper GI bleeding occurs, the blood is digested to protein[12]. This protein is transported to the liver via the portal vein, and metabolized to BUN in the urea cycle[13]. Higher BUN values are therefore associated with the digestion of blood[14].
GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn’s disease, colonic polyps, or cancer in the colon, stomach or esophagus.
What are the variables that contribute to an upper GI bleed?
Common risk factors for upper GI bleeding include prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age. Causes of upper GI bleeding include peptic ulcer bleeding, gastritis, esophagitis, variceal bleeding, Mallory-Weiss syndrome, and cancer.
What is the most common cause of lower GI bleeding?
Colonic diverticulosis continues to be the most common cause, accounting for about 30 % of lower GI bleeding cases requiring hospitalization. Internal hemorrhoids are the second-most common cause.
What are the types of GI bleeding?
ABSTRACT: Gastrointestinal bleeds (GIBs) are a significant source of hospitalizations in the United States. GIBs are categorized into two types: upper GI bleeds and lower GI bleeds. Each type can present with different hallmark presentations and require different management.
What is the pathophysiology of melena?
Melena, is stool with blood, that has been altered by the gut flora, and appears black/”tarry”.
What is the difference between Melaena and occult blood?
Overt OGIB refers to visible bleeding (i.e. melena or hematochezia), whereas occult OGIB refers to cases of fecal occult blood positivity and/or unexplained iron deficiency anemia.
What is the most common cause of upper GI bleeding?
Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining of the stomach and upper portion of the small intestine.
What are the differences between an upper and lower GI bleed?
Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine. Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.
What is the difference between upper and lower GI bleed?
What causes bleeding in the small intestine?
Upper GI (esophagus, stomach, or duodenum) bleeding is most often due to ulcers. In the small bowel, 30 to 40% of bleeding is caused by abnormal blood vessels in the wall of the small bowel. These abnormal blood vessels have many names, including angioectasias, angiodysplasias, or arteriovenous malformations (AVMs).
What is the difference between upper GI bleeding and lower GI bleeding?
If bleeding occurs in your esophagus, stomach, or initial part of the small intestine (duodenum), it’s considered upper GI bleeding. Bleeding in the lower small intestine, large intestine, rectum, or anus is called lower GI bleeding.
What is the difference between melena and hematochezia?
Melena is the passage of black, tarry stools. Hematochezia is the passage of fresh blood per anus, usually in or with stools.