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| ==Background==
| | {{GI bleeding pages}} |
| *Loss of blood from the GI tract distal to the ligament of Treitz
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| *Upper GI bleeds are most common source for blood detected in the lower GI system
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| *80% of lower GI bleeding will resolve spontaneously
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| *Cause for bleeding is found in <50% of cases
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| ==Diagnosis==
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| ===History===
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| *Hematochezia
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| **Bright red or maroon-colored bleeding that comes from the rectum
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| **Usually represents lower GI bleeding
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| **May represent UGIB if bleeding is brisk
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| ***Usually accompanied by hematemesis and hemodynamic instability
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| *Melena
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| **Usually represents bleeding from upper GI source
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| **May represent bleeding from lower GI source due to slow bleeding
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| ==DDX==
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| #Upper GI bleed
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| #Diverticular disease
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| ##Painless bleeding
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| ##Up to 90% of episodes resolve spontaneously
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| ##Can result in massive hemorrhage
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| #Vascular ectasia
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| ##Angiodysplasia, AVM
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| #Inflammatory bowel disease
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| #Colitis
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| ##Infectious
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| ##Ischemic
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| ###90% of cases occur in age >70yo
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| ###Colon is predisposed to ischemia due to poor vascular ciculation, high bacterial count
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| ###Causes: aneurysmal rupture, vasculitis, hypercoagulable, CV insult, IBS, slow motility
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| ###Most cases resolve on own; 20% of cases requires surgical intervention
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| #[[Mesenteric Ischemia]]
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| ##Medical emergency that often leads to bowel necrosis
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| ##Causes: thrombosis/embolism of SMA, mesenteric vein thrombosis, low arterial flow
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| ##Associated w/ A fib, CHF, MI, age >60yo
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| ##CT only 64% Sn, angiography is imaging study of choice
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| #Meckel Diverticulum
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| #Malignancy / polyps
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| #Hemorrhoids
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| ##Massive hemorrhage is unusual
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| #Rectal ulcer
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| #Foreign body
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| #Rectal ulcer (HIV, syphilis, STIs)
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| #Anal fissure
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| ===Consider===
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| #Proctoscopy (22cm from anal verge)
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| #Sigmoidoscopy (60cm from anal verge)
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| #Angiography (requries arterial bledding >0.5cc/min)
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| #CT angio
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| ==Disposition==
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| Rockall score
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| ===Home (very low risk)===
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| #No comorbid dz
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| #Normal vitals
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| #Norma/trace pos guiac
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| #Normal/near-normal Hb
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| #Home support
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| #F/U within 24hrs
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| ===Ward/Stable (low risk)===
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| #Age <60
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| #Initial SBP >100
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| #Normal vitals x 1hr
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| #No transfusion req
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| #No major comorbid
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| #No liver dz
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| ===ICU===
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| #Normal or dec Hct
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| #Blood in NG doesn't clear
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| #SBP<100, HR>100
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| #Gauaic +/- stool
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| ==False Positive Guaiac==
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| #Red fruits and meats
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| ##(Bananas, turnips, broccoli)
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| #Methylene blue
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| #Chlorophyll
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| #Iodide
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| #Cupric sulfate
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| #Bromide
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| #Iron (causes GI bleed by irritation)
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| ==Source ==
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| *Tintinalli
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| [[Category:GI]] | | [[Category:GI]] |
| | [[Category:Symptoms]] |
