Classification of gastrointestinal bleeding
A basic distinction is made between upper and lower gastrointestinal bleeding. The upper gastrointestinal tract consists of the stomach, the upper sections of the small intestine, i.e. the duodenum (medical term: duodenum) and the transition to the empty intestine (jejunum), known as the “flexura duodenujejunalis”. The reason for this division into upper and lower gastrointestinal bleeding (GI bleeding) based on the flexura duodenujejunalis is due to the different approach of the physician in diagnosis and therapy:To detect upper gastrointestinal bleeding (GI bleeding), endoscopes (tubular camera) are used, which are placed over the patient’s mouth (after administration of a sedative, d. The endoscopes are inserted into the patient’s mouth (after administration of a sedative drug, such as midazolam, a short-acting benzodiazepine), advanced into the stomach and allow the physician to see inside the patient’s digestive tract up to this transition point of the two sections of the small intestine (flexura duodenujejunalis).
If the presumed source of bleeding in an intestinal hemorrhage is even deeper (medically: further distal, towards the anus), the device must be inserted via the intestine. This means that a colonoscopy must be performed, which also reaches the last and third section of the small intestine, the ileum. It should be noted that although this classification is still useful today, as the upper and lower gastrointestinal bleeding (gastrointestinal bleeding) differ significantly with regard to the causes, the age groups affected and also in the choice of treatment method, the original origin of the classification is today only of limited validity due to more modern endoscopes with greater range.
How is gastrointestinal bleeding diagnosed?
The diagnostic procedure depends, as just described, on the type of gastrointestinal bleeding: If tarry stools occur, an endoscope (tube camera) is inserted as an emergency measure after questioning the patient about the possible course of events (known previous illnesses or risk factors, medications taken, possible injuries, last meals taken, etc.) to diagnose bleeding in the upper gastrointestinal tract (gastrointestinal tract). If a gastrointestinal bleeding can be ruled out there, the source must be found in the large or small intestine.Detection is done by the administration of radioactively marked red blood cells (the process aimed at detecting the emitted radioactive radiation is called scintigraphy).
This is followed by the selective diagnosis of the affected vessels, which allows a more precise localization. The value of an emergency colonoscopy (colonoscopy) performed without appropriate preparation of the intestine is controversial, as the information value is limited in the case of an intestine that has not been previously cleaned with laxatives and the examination is technically difficult. The procedure for vomiting blood (haematemesis) is similar to the procedure for removing tarry stools; however, in the case of massive bleeding, emergency surgery is indicated immediately.
If red arterial blood is present in the excreted stool (hematochezia), digital-rectal diagnosis (examination of the anus with the finger) is often started, as the palpating finger of the examiner can quickly detect palpable neoplasms and tissue injuries (ulcerations) as well as hemorrhoids hardened by blood coagulation. If this measure is not successful, the following examination procedures are also performed here: endoscopy (in this case an endoscopy of the rectum, also known as rectoscopy) and the imaging of the vessels with contrast medium (angiography) or radioactively marked substances (scintigraphy).
