Gastrointestinal Bleeding Symptoms And Clinical Manifestations

Gastrointestinal bleeding, particularly in the upper digestive tract, can present with various clinical symptoms. Recognizing these signs is crucial for timely diagnosis and treatment.

Key Symptoms Of Upper Gastrointestinal Bleeding

1. Hematemesis And Melena

One of the most characteristic signs of upper gastrointestinal bleeding is hematemesis (vomiting blood) and melena (black, tarry stools). When the bleeding occurs above the pylorus, it often results in both vomiting of blood and dark stools. In cases where the bleeding is below the pylorus, or when the bleeding is slow and minimal, melena may be the only symptom. However, in situations involving rapid and significant bleeding from a lower location, blood can reflux into the stomach, causing hematemesis as well.

2. Hypovolemic Shock

Significant blood loss can lead to hypovolemic shock, especially when the volume exceeds 400 ml. Patients may experience dizziness, palpitations, fatigue, and dry mouth. If the bleeding surpasses 1000 ml, more severe symptoms such as fainting, cold and clammy extremities, reduced urine output, restlessness, confusion, or even unconsciousness may occur. This level of blood loss can be life-threatening and requires immediate medical attention.

3. Azotemia

Following a bleeding episode, blood urea nitrogen (BUN) levels typically rise within a few hours and peak within 24 to 48 hours. This condition, known as azotemia, usually resolves within three to four days as the body stabilizes and clears the excess nitrogenous waste.

4. Anemia And Blood Cell Changes

Acute, massive bleeding often results in hemorrhagic anemia. Initially, hemoglobin levels may not drop immediately, but signs of anemia typically appear after three to four hours. Additionally, white blood cell counts may increase significantly within two to five hours after the onset of bleeding and usually return to normal within two to three days after the bleeding stops.

5. Fever

Patients experiencing moderate to severe bleeding may develop a low-grade fever within 24 hours. This fever generally lasts for three to five days before subsiding as the body recovers.