Definition

Bleeding from the gastrointestinal tract (GI) is an important surgical emergency that requires urgent evaluation and assessment if major morbidity and mortality is to be avoided. After initial assessment of haemodynamic status and resuscitation, attention should be drawn to trying to determine the site of bleeding as well as potential comorbidities.

Classification

Upper gastrointestinal haemorrhage is defined as bleeding occurring in the GI tract proximal to the ligament of Treitz (duodenojejunal flexure) whereas lower gastrointestinal haemorrhage is defined as bleeding arising in the bowel distal to this.

History

Patients commonly present with GI bleeding either to the emergency department, or often during hospital admission for another illness. In most cases the history offers the best clue as to the site of potential haemorrhage:

Bleeding: the mode of bleeding (haematemesis versus rectal bleeding), type (bright red, clotted, altered blood/melaena), and quantity of blood and duration of symptoms offer vital clues.Melaena refers to blood that has been partially digested by enzymes rendering it black and ‘tar-like’ in appearance and very foul smelling. Dark clotted blood usually results from a proximal lower GI bleed, but may be confused with melaena. Bright red bleeding usually implies a distal lower GI bleed.Note that a massive upper GI bleed may also present with bright red bleeding although the patient is usually very haemodynamically unstable in this case. Occult bleeding refers to a slow and intermittent pattern of blood loss and does not pose an immediate threat though warrants investigation.

Change in bowel habit: may signify underlying pathology.