Is it hard to find the "blood trace"? The great detective of upper gastrointestinal bleeding will teach you how to find the "troublemaker" in your body!

Author: Yan Liping, Fifth Medical Center, PLA General Hospital

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

Upper gastrointestinal bleeding refers to gastrointestinal bleeding above the suspensory ligament of the duodenum, including bleeding caused by lesions of the esophagus, stomach, duodenum, pancreas, gallbladder, etc., as well as bleeding from jejunal lesions after gastrojejunostomy. Massive upper gastrointestinal bleeding generally refers to blood loss exceeding 1000 ml or 20% of circulating blood volume within a few hours, mainly manifested as vomiting blood and/or black stools, often accompanied by decreased blood volume causing acute peripheral circulatory failure, and severe cases can lead to hemorrhagic shock and endanger life. Therefore, accurate identification of upper gastrointestinal bleeding is not only a severe test for medical professionals, but also a key skill that patients and their families must master. However, the symptoms of upper gastrointestinal bleeding may vary greatly depending on the amount of bleeding, bleeding speed and location of the lesion. Today, we will lead you to have a deep understanding of the relevant knowledge of upper gastrointestinal bleeding, and strive to help you detect, diagnose and treat it early, so as to gain precious treatment time for patients.

1. What are the common causes of upper gastrointestinal bleeding?

Clinically, the most common causes of upper gastrointestinal bleeding are peptic ulcer, rupture of esophageal and gastric varices, acute erosive hemorrhagic gastritis and gastric cancer, which account for 80% to 90% of upper gastrointestinal bleeding.

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2. What are the clinical manifestations of upper gastrointestinal bleeding?

The clinical manifestations of upper gastrointestinal bleeding mainly include vomiting blood, black stools, bloody stools, tarry stools, etc. If the patient bleeds a lot and bleeds quickly, he may experience dizziness, fatigue, palpitations, cold sweats, thirst, pale skin, and even loss of consciousness.

Some patients with cirrhosis may experience upper abdominal distension, nausea, and anal urgency to defecate before experiencing symptoms such as vomiting blood, black stools, bloody stools, and tarry stools. They may also have precursor symptoms such as pale complexion, cold sweats, palpitations, and dizziness.

3. What are hematemesis, black stools, bloody stools, and tarry stools?

1. Hematemesis: Bleeding in the esophagus, stomach, duodenum, bile duct, etc., vomiting blood through the mouth is called hematemesis. After bleeding, the blood is retained in the stomach and becomes brown after being acted upon by gastric acid. If the bleeding speed is fast and the amount of bleeding is large, the color becomes bright red.

2. Black stool: After upper gastrointestinal bleeding or small intestinal bleeding, the blood stays in the intestinal cavity for a long time and forms black feces after sulfidation and is discharged from the body. Black stool can sometimes also be seen after taking certain Chinese herbal medicines, bismuth-containing drugs, and blood-containing foods (pig blood, duck blood, etc.).

3. Bloody stool: Blood discharged from the anus is called bloody stool. The stool may be bright red, dark red or tarry in color.

4. Tarry stool: The stool is black in appearance, shiny, sticky, and has a bloody smell. It is seen after upper gastrointestinal bleeding.

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4. How to differentiate upper gastrointestinal bleeding from lower gastrointestinal bleeding?

Lower gastrointestinal bleeding refers to gastrointestinal bleeding below the suspensory ligament of the duodenum, mainly including bleeding in the small intestine, large intestine (colon and rectum) and anus. Bleeding in different parts may require different hemostatic methods and drug treatments. Correctly distinguishing between upper and lower gastrointestinal bleeding is of great significance for assessing the condition, improving diagnostic accuracy, guiding treatment and preventing recurrence. We can make a comprehensive judgment based on the patient's symptoms, medical history, stool characteristics, etc. to determine the location and cause of bleeding. The distinguishing points between upper and lower gastrointestinal bleeding are shown in the figure below.

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