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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 | | *[[GI Bleeding (Peds)]] |
| *Cause of bleeding found in <50% of cases | |
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| ==False Positive Guaiac==
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| #Red meat
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| #Red jello
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| #Fruit and vegetables
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| ##(Melon, broccoli, radish
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| #Iron (causes GI bleed by irritation)
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| ==Diagnosis==
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| ===History===
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| *Type of blood
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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 | |
| ***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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| *Medications
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| **Salicylates, NSAIDs, warfarin
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| ===Physical Exam===
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| #Consider anoscopy if source of bleeding cannot be identified on external exam
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| ==Workup==
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| #Labs
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| ##CBC
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| ###Chemistry
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| ###BUN may be elevated if bleeding occurs from site high in GI tract
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| ##Coags
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| ##LFTs
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| ##Type and screen
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| #ECG (if concern for silent ischemia inn pts likely to have CAD)
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| #Imaging
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| ##CTA
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| ###Requires brisk bleeding rate (0.5 cc/min) for detectio
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| ##Proctoscopy (22cm from anal verge)
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| ##Sigmoidoscopy (60cm from anal verge)
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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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| ==Treatment==
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| #IVF
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| #Correct coagulopathy
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| #Blood
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| ##Give if continued active bleeding and failure to improve perfusion after 2L NS
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| #?NGT
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| ##Hematochezia unexpectedly originates from upper GI source 10-15% of cases
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| #Sigmoidoscopy/colonoscopy
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| #Surgery if endoscopy fails or not available
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| ==Disposition==
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| Discharge:
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| **Bleeding from hemorrhoids, anal fissures, or known IBD (hemodynamically stable)
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| **No gross blood on rectal exam (hemodynamically stable)
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| ==Source ==
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| *Tintinalli
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| [[Category:GI]] | | [[Category:GI]] |
| | [[Category:Symptoms]] |