Gastrointestinal Bleeding – Part 3
Before surgeons can treat a bleeding source, they most optimally should diagnose the location in the GI tract. After making sure the patient is stable and having blood sent to the laboratory, most surgeons recommend the insertion of a nasogastric tube or NG tube. If the tube returns blood then there is at a minimum a bleeding source in the stomach (although rare, there can be two
simultaneous bleeding sources). If there is no blood returned after the NG tube is placed, a lavage or washing out of the stomach is performed by placing room temperature saline solution into the NG tube and then aspirating it with a syringe. This must be done until the fluid returned shows the greenish tint of bile, which is released into the GI tract from the liver just distal or beyond the end of the stomach. It is possible for a brisk bleed to be happening just past the end of the stomach that lavage through a NG tube might miss. However, if there is bile in the returned lavage fluid and no blood, bleeding in the stomach and first part of the duodenum can usually be eliminated.
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