Difference between revisions of "Gastrointestinal bleeding"

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

Latest revision as of 23:10, 28 November 2019