Gastrointestinal Bleeding

Gastrointestinal Bleeding or GI bleeding refers to bleeding from any part of the gastrointestinal tract, from the mouth and esophagus to the stomach or intestines. Gastrointestinal bleeding can occur due to infection or medications that damage tissues leading to bleeding. GI bleeding needs to be monitored carefully and attended to. Upper Gastrointestinal bleeding can result from gastritis or peptic ulcers. Lower GI bleeding is often due to diverticulitis, polyps, anal fissures or hemorrhoids.

Acute GI bleeding manifests in bloody bowel movements and vomiting of blood. There is fatigue and weakness. The patient suffering GI bleeding may suffer pain in the abdomen. A person suffering from gastrointestinal bleeding experience thirst, low blood pressure and dizziness. The patient may notice black tarry stools.

Laboratory tests, Endoscopy and rectal examinations may be needed to determine the source of the gastrointestinal bleeding. Excessive bleeding can lead to anemia. In severe cases, it can lead to shock and may need hospitalization for further treatment. There might be need for blood transfusion. Upper GI bleeding can be treated with injection of chemicals. Medicines are then prescribed to prevent the bleeding from recurring. If polyps or hemorrhoids are the cause for gastrointestinal bleeding, they are surgically removed.

Tranexamic Acid

Tranexamic acid is used in the control of heavy bleeding or menorrhagia during periods. Since, this acid helps to stop blood clots from breaking down, bleeding is reduced. The lining in the womb clots and thus when you are having a period, it will reduce the heavy bleeding, though it will not stop the period altogether. By controlling heavy bleeding, it reduces the amount of blood loss with minor side effects. Tranexamic acid is an Antifibrinolytic medicine and is also called Cyklokapron which is available both in tablets and injection form.

Normally, when you bleed, your body forms clots to stop bleeding. In some, these blood clots break down and the bleeding continues and it is here that Tranexamic acid comes into play to stop the clots breaking down and thus reduce unwanted bleeding.

Conditions in which Tranexamic acid is used

Apart from heavy bleeding during periods or menorrhagia, Tranexamic acid is used in conditions such as unwanted or heavy bleeding post surgery, such as that on the prostrate, bladder and cervix, nosebleeds, bleeding inside the eye, during tooth extraction when bleeding is more than normal, and in conditions like Hemophilia and hereditary angioedema.

Precautions before consuming Tranexamic acid

Not all medicines suit all persons and with certain conditions, sometimes a medicine may only be used if extra precaution is taken. It is imperative to inform the medical practitioners before starting on Tranexamic acid:

• If you are pregnant or breast-feeding or planning to become pregnant.
  
• If there are problems in kidneys and blood in urine.
  
• If there has been a recent blood clotting problem.
  
• If you have had fits
• If you are on any medication, herbal medicines or contraceptive pill.
  
• If the time between the start of periods is less than 21 days or more than 35 days.

Use of Tranexamic acid is not advised if:

• You are allergic to any ingredient in Tranexamic acid
  
• If there are blood clots in the leg, lung, eye, brain and a history of blood clots or conditions that risk blood clots such as heart valve problems, and irregular heartbeat etc.
  
• If there is bleeding in the brain, blood in urine or bleeding related to kidney problems
  
• Disturbance in color vision
  
• Irregular menstrual period bleeding of unknown cause
  
• Using birth control that contains estrogen and progestin
  
• Using Medications which promote bleeding - eg. aspirin
  
• Using medicines to help blood clot such as factor IX complex concentrates or anti-inhibitor coagulant concentrates.

Taking Tranexamic acid

It is essential to read the manufacturer's information leaflet before you start treatment. The tablets have to be taken exactly the way your medical practioner has prescribed, on the dosage and also the number of tablets to consume daily. The dose will vary from person to another. The tablets have to be swallowed drinking water - do not crush or chew them. You can instead crush the tablet and mix it with a small amount of soft food such as yogurt, honey or jam. In case of liquid medicine, the right amount using an oral syringe or medicine spoon has to be measured. You cannot use a kitchen spoon as it will not give the right amount. Tranexamic acid can be taken before or after food. The medicine will start working right away and will reduce the bleeding on the first day.

In case you have forgotten, better to go on with the next dose, and not to take the missed dose. Only take Tranexamic acid after periods have started. Not more than three doses can be taken (6 tablets) within 24 hours. It should not be taken for more than five days within any menstrual cycle. Thrice daily means, this should be once in the morning, once in the early afternoon and once in the evening. Ideally, these times are at least six hours apart, say, 8 am, 2 pm and 8 pm.

It is also important to keep regular appointment with the doctor. Tranexamic acid is taken for short duration only. In case you are undergoing any operation or dental treatment, remember to tell the doctor about taking Tranexamic acid.

Side effects of Tranexamic acid

Though not all experience these, some do suffer these side effects due to Tranexamic acid consumption:

• Diarrhea,
  
• Eyesight problems, such as with color vision
  
• Back pain, headache, joint pain, muscle pain
  
• Spasms, cramps
  
• Nasal congestion
  
• Stomach pain
  
• Severe allergic reactions such as itching and difficulty in breathing
  
• Swelling in mouth, face, lips and tongue, and flushing of face
  
• Chest pain
  
• Confusion
  
• Coughing up blood
  
• Decreased or difficulty in urination
  
• Eye problems
  
• Numbness in arm, leg or one sided weakness, seizures
  
• Unusual tiredness or weakness

If you are feeling sick, stick to simple meals, and avoid rich and spicy food. Also, it would be better to take tablets after meals. In case of diarrhea, take plenty of water to replace the lost fluids. Never take more than the prescribed dose and do not use outdated medicines. Seek medical attention right away if the side-effects persist.

Tranexamic acid precautions

It is imperative to keep medicines out of reach of children and pets; and also store in a cool place, away from direct sunlight. Tranexamic acid is stored at room temperature and should be kept away from heat, moisture and light. Do not store in the bathroom.

As this acid may cause dizziness, and it may worsen if it is taken with alcohol or certain other medicines, it is better to use it with caution. It is recommended not to drive until you know how you react to it. If your symptoms do not get better after two menstrual cycles and instead get worse, it is better to stop the acid and instead check with the doctor.

The risk of heart attack, stroke, or other blood clots may increase with Tranexamic acid use with hormonal birth control pills. This risk is even greater if you are overweight, or a smoker and are older than the age of 35. Tranexamic acid should be used with utmost caution in children younger than 18 as well as the elderly.

Internal Bleeding

Bleeding in general is an alarming sign to the body. Comprehensive analysis is taken into consideration in evaluating the appropriate cause of the bleeding. This enables a prophylaxis approach and also categorizes the type of bleeding into internal or external. Internal bleeding is associated with many pre-existing conditions. In many cases internal bleeding may occur because of a trauma caused in a particular region affecting a vital organ of the body.

Clinical signs and evaluations of internal bleeding

External bleeding has causes such as wounds, laceration or an injury. Internal bleeding is difficult to identify. It is necessary to identify the exact location and damage of the blood vessel be it an artery or a vein. The body's only responses to such damages are clot formation through platelet aggregation and also thrombus. This immediate response of the body is to prevent hemorrhage and hypoxia in the organ systems.

Many clinical parameters are evaluated in the emergency room to understand and identify the exact cause of the bleeding inside the body. In case of internal bleeding, patients are immobilized to avoid further damage. Underlying fractures and bone disruptions are evaluated in case of internal fractures. Body orifices should be administered with dressings to prevent blood loss and infection. Vital parameters such as oxygen saturation, blood pressure, and pupil analysis are done to evaluate hypoxia and heart rate in case of trauma. Neurological, cardiovascular, respiratory and musculoskeletal systems are examined for blood vessel damage and associated prominent complaints of pain.

After thorough examination of the patient and recording the history, radiological investigations are required to detect vital organ damage. Surgical interventions are required in case of fracture, brain hemorrhage and other adverse organ damage. In patients who are on anticoagulants and blood thinning medications, internal bleeding is imminent in case of trauma.

In case of internal bleeding associated organ damage, the predominant reason is the damage of blood vessels in the organ due to compression. Most common examples are abdominal injuries caused during sports such as football and wrestling. Head injuries are more common in sports associated with more physical contact such as martial arts and boxing. Other important reasons are shift in internal organs in case of trauma. Internal bleeding is directly associated with long term alcohol consumption as it affects the blood vessels of the hepatic portal system. The complications associated with internal bleeding are severe as they may lead to death of the patient. This happens when transfusion doesn't happen on time.