Upper Gastrointestinal Bleeding

Upper Gastrointestinal Bleeding

Types of bleeding from the upper gut
The type of bleeding is sometimes described as follows:

• Dark blood. This is often referred to as a ‘coffee ground’ colour. The blood has been in contact with stomach acid long enough for the acid to turn the blood a dark browny red colour.
• A large amount of bright red blood (haematemesis)
• Melaena. Melaena means that your poo (faeces/stools) has become very dark or black, and
  often a tar-like consistency. Vomiting blood and melaena are symptoms that often go together.

What is haematemesis?

• Haematemesis is the medical word for vomiting of blood. This symptom is usually due to a problem within the upper gut. That is, the gullet (oesophagus), stomach or the first part of the small intestine (duodenum).
• Vomiting of blood is a medical emergency. Even though in many cases the bleeding will stop quite quickly, you cannot be sure it will stop when you first start to vomit blood. In some cases the bleeding can become severe and life-threatening.

What are the causes of vomiting blood?
There is a range of different causes – discussed below. Many causes can be treated but the first
priority is to make sure the bleeding stops.

Bleeding from the gullet (oesophagus)
Causes include:

• Inflammation of the oesophagus (oesophagitis) is often due to acid reflux from the stomach (gastro-oesophageal reflux disease [GORD]). The inflamed oesophagus sometimes bleeds.
• Oesophageal cancer sometimes causes bleeding into the oesophagus.
• Oesophageal varices. Varices are dilated blood vessels usually in the lining of the gullet or stomach. They are a possible complication of liver disease
• Mallory-Weiss syndrome. This is bleeding caused by a tear in the lining of the oesophagus or stomach.

Bleeding from the stomach
Causes include:

• Stomach (gastric) ulcer. An ulcer may bleed, sometimes heavily. Anti-inflammatory medicines that are used to treat conditions such as arthritis sometimes cause stomach ulcers. Aspirin is also a cause.
• Stomach cancer sometimes causes bleeding into the stomach.
• Inflammation of the stomach lining (gastritis) has similar causes to ulcers.

Bleeding from the first part of the small intestine (duodenum)
Causes include:

• Duodenal ulcer. An ulcer may bleed, sometimes heavily. Like stomach ulcers, a duodenal ulcer is usually caused by an infection with the germ (bacterium) called H. pylori or anti-inflammatories.

What assessment and tests may be done?

A doctor’s assessment
Following your period of observation on the CDU your observations remained stable and it is safe for you to be discharged. We now need to undertake tests to identify the cause. The main test that we perform is an endoscopy.

Endoscopy
An endoscopy (gastroscopy) is where a thin, flexible telescope is passed down the oesophagus into the stomach and to the upper duodenum. The cause of the bleeding can often be identified by endoscopy. You should be called for an endoscopy within 7 days of discharge from the CDU.

Assessing your general situation
Various other tests have been done to assess your general situation (for example, blood tests help to assess such things as your liver function), and we have looked at other things to help diagnose or assess other causes of the bleeding, such as checking what medications you are taking. We have also started you on an anti-acid medication (omeprazole) to reduce the amount of acid your stomach produces.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]
Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.
If you are unable to understand this leaflet, please communicate with a member of staff.

For additional medical advice, if your symptoms or condition worsens:
Contact your GP
NHS 111: Telephone 111
Get help with your symptoms, NHS111: https://111.nhs.uk/
Information to help you manage your health: www.nhs.uk
In an emergency telephone 999

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