Upper and Lower Digestive System Bleeding and Associated Complications

Personal and Social History

Did You Find Any Remarkable Detail In The Personal And Social History Of Our Patient That Can Help To Make The Diagnosis? What Results Do You Expect To Find In The Tests Ordered?

What Are Some Future Complications The Patient Is At Risk Of Developing?

What Organs Are Included In The Upper Digestive System? Mention And Explain At Least Three Other Conditions Of The Upper Digestive System That May Be a Cause Of Digestive Bleeding. What Specific Sign On The Physical Exam Is Characteristic Of Upper Digestive System Bleeding?

What Organs Are Included In The Lower Digestive System?

What Are Some Causes Of Lower Digestive System Hemorrhages, And How Do You Differentiate Them From Upper Digestive System Hemorrhages?

According To The Patient's Previous Medical History, It Is Possible That He Has Cirrhosis Of The Liver? Why?

Can Cirrhosis Of The Liver Be a Cause Of Upper Digestive Bleeding? What Is The Prognosis? Explain. Are There Any Specific Risk Factors Of Diseases Of The Gallbladder Or Pancreas? If So, Why, And What Is The Prognosis?

The patient Mr. Cristopher Franklin, a male, is 60 years old and has a medical history of thrombotic cerebrovascular accident two years back. The symptoms include sever epigastric pain, which increases when the patient intakes food and drinks. The feces of the patient is dark and he feels dizziness, malaise and complains of suffering from pyrosis. The clinical signs as observed by the healthcare professional includes pain on palpation on epigastric region, coldness, diaphoresis, pallor and tachycardia.

The patient smokes cigarette and was a heavy drinker, which he ceased when he had a stroke. These characteristics from the social life of the patient can be crucially correlated with the personal aspect of family incidents, as the patient has a history of family members dying from cirrhosis of liver and colon cancer, both of which are disorders of gastrointestinal and digestive system (Aberg et al., 2019). These characteristics should lead be included to mark the diagnostic procedures for the patient.

The lab results for the complete blood count will help to determine the extent of bleeding and also determine whether the patient has anemia due to excessive bleeding. The cause of the bleeding will be determined using the interpretation of image generated by Abdominal CT scans. With the help of upper GI endoscopy, the site of bleeding and its cause will be determined.

Diagnostic Procedures

Upper gastrointestinal bleeding causes significant and critical morbidity. Rebleeding is one of the major complication that the patient is likely to suffer from in the future. According to Sonnenberg (2012), patient mortality chances increases with the subsequent increase in complications due to GI bleeding.  

There are several organs in the upper digestive system, the major of which are esophagus, stomach and the duodenum. Abnormality in these three major organs from the upper digestive can lead to bleeding in the system. One of the primary cause of upper GI bleeding is peptic ulcers. Open sores develop in the lining of the major organs from the upper digestive system and these peptic ulcers are often caused by the Helicobacter pylori infection (Lanas & Chan, 2017). Another cause of GI bleeding in the upper digestive system includes the condition of esophageal varices, which is caused by enlarged and abnormal veins in the esophagus to cause bleeding. Another cause of GI bleeding is the medical condition of Mallory-Weiss tears, in which tears on the walls of the esophagus to cause a lot of bleeding (Ghanimeh et al., 2017).

Pain on palpation in epigastric region is the sign that is indicating bleeding in the upper digestive system. Other signs include Coldness, pallor, and diaphoresis, which are indicating loss of blood.

The key organs in the lower digestive system are some part of the small intestine and the complete large intestine, the anus, rectum, colon and cecum. Few of the possible causes of lower GI hemorrhage includes diverticulosis, colitis, angiodysplasia, hemorrhoids, and rectal varices (Adegboyega & Rivadeneira, 2019).

There are several differentiating indicators to distinguish between the upper and low GI bleeding. Hematemesis indicates source of bleeding to be in upper digestive system. Melena indicates extended presence of blood in the GI tract, for at least 14 hours, indicating lower GI bleeding (Whelan et al., 2010). Hematochezia represents the source of bleeding to be in lower GI tract. However, brisk draining of blood in the upper GI tract may lead to situation where the blood does not stays long enough in the tract to form melena, and is an indicator of dropping hemoglobin and hemodynamic instability (Mendo et al., 2020).

The patient’s father died of cirrhosis of the liver, which leads to the possibility of the same to be present in the patient. Even though cryptogenic cirrhosis cases are not usually inherited, family history of liver disease significantly increases the risk of the same to be present in the patient.  Patients with liver cirrhosis may develop upper GI bleeding due to gastroesophageal varices, lesions or portal hypertensive gastropathy. The prognosis of liver cirrhosis indicates long-term liver damage which is fatal and can lead to mortality if the organ is not transplanted. For advanced stages of cirrhosis, the patient’s life expectancy can be limited between 6 months to 2 years. The prognosis of liver cirrhosis depends upon the type and stage of cirrhosis, and this particular case, as the patient as ceased drinking couple of years back, it is expected that the recovery rate will slightly increase and can go up by 35% to 5 years.

Certain risk factors for diseases in gall bladders and pancreas include gallstones, alcoholism, certain medication, hypercalcemia, obesity, bile duct abnormalities, bile duct cysts and older age.  

References

Aberg, F., Puukka, P., Sahlman, P., Nissinen, M., Salomaa, V., Mannisto, S., ... & Farkkila, M. (2019, April). Genetic risk factors for advanced alcoholic and non-alcoholic liver disease in the general population. In Journal of Hepatology (Vol. 70, pp. E753-E754). PO BOX 211, 1000 AE 

Amsterdam, Netherlands: Elsevier Science Bv.Adegboyega, T., & Rivadeneira, D. (2019). Lower GI Bleeding: An Update on Incidences and Causes. Clinics in Colon and Rectal Surgery, 33(1), 28-34.Ghanimeh, M. A., Kaddourah, O., Hassan, S., Abughanimeh, O., Qasrawi, A., Abuamr, K., & Yousef, O. (2017). Mallory-Weiss Tears, Risk Factors and Predictors of Endoscopic Intervention: A Severe Complicated Course or Higher Risk of Rebleeding: 568. American Journal of Gastroenterology, 112, S305-S306.Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.Mendo, R., Figueiredo, P. C., & Albuquerque, C. (2020). An Unusual Cause of Hematochezia.

Clinical Gastroenterology and Hepatology, 18(3), e36.Sonnenberg, A. (2012). Reliability measures in managing GI bleeding. Gastrointestinal endoscopy, 75(6), 1184-1189.Whelan, C. T., Chen, C., Kaboli, P., Siddique, J., Prochaska, M., & Meltzer, D. O. (2010). Upper versus lower gastrointestinal bleeding: a direct comparison of clinical presentation, outcomes, and resource utilization. Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine, 5(3), 141-147.