GI Bleeding Flashcards
Type of bleeding
- Upper: Hematemesis
- Lower: Melena
- Rectorrhagia = bright red rectal bleeding
Upper & Melena
1- Very little bleed
2- 1st & 2nd part of duodenum but pylor spasm
Infant (29d - 1yr)GI bleed reasons
1- Bacterial enteritis
2- Milk protein allergy
3- Intussusception
4- Maternal blood
5- Anal fissure
6- Lymphonodular hyperplasia
Bacterial enteritis
- Bloody diarrhea
- Shigella, Yersinia, Helicobacter, E. Coli, Salmonella, Amoeba
Milk protein allergy
Most common: Bloody stool w/o diarrhea
- Resolves til 1yr
- No complaints (kid) except bloody stool
- Diet milk (if baby formula)
Intussusception
- Different places and names
- No Peristalsis
- 3m-3y Idiopathic
- <3m or >3y needs lead point (polyp, submucosal bleed, intestinal lymphoma)
Intussusception causes _____
- Hyperemia
- Venous Return problem
- Blood and fluid goes to intestine
- Artery obstruction (Very Painful)
Intussusception clinical manifestations
- Sudden crying then calming down then crying again after 1-2h
- Increasing frequency
- Telephone
- Hard stomach
- Can be touched in RUQ
Maternal Blood
- 1-2h after birth
- Nipple fissure
Lymphonodular hyperplasia
Allergy
- لبنیات، تخم مرغ، مغزیجات، ماهی و دریایی، سویا، کنجد
- In colonoscopy
Children GI bleed reasons
1- Bacterial enteritis
2- Anal fissure
3- Colonic polyps
4- Intussusception
5- Peptic disease
6- Swallowed epistaxis
7- Mallory-weiss syndrome
Colonic polyps
- Bleeding & pain
- Can cause obstruction & intussusception
- Diagnosis & treatment = colonoscopy, polypectomy
Peptic disease
Stomach acid on stomach or duodenum mucous
- Gastric or duodenal + Inflammation, Erosion, Ulcers
- Food related (better or worse)
- Epigastric
Treatment = PPI (-prazole)
Mallory-Weiss syndrome
- Esophagus tear
- Forceful retching
- Distal esophagus
Teen GI bleed reasons
1- Bacterial enteritis
2- IBD
3- Peptic disease
4- Mallory-weiss
5- Colonic polyps
IBD
Ulcerative colitis (1), Crohn’s (2)
Differences
- (1)just large intestine, (2) whole GI
- (1) single ulcer, (2) multiple
- (1) mucus and submucosal layer, (2) all layers so fistula
- (1) goes up from rectum
Rare infancy GI bleed reasons
1- Volvulus
2- Meckel diverticulum
3- NEC (Necrotizing EnteroColitis)
4- Stress ulcer
5- Coagulation disorders
Volvulus
- Intestine twist around itself
- Sigmoid
- Bloody stool
Meckel diverticulum
- Most common congenital GI anomaly
2 rule - 2% of people
- 2 foot from ileocecal
- 2 inch max
- 2 out-of-place tissues (stomach, pancreas)
- 2 problems (bleeding, perforation)
- Onfalomesentrico (in open, out closed)
- Can mimic appendicitis
- Has stomach tissue so acid
NEC
- Premature, NICU, High calorie, Sepsis
- Small bleeding ulcers
- Typic = sepsis + blood from rectum
- Treatment = Ab + Electrolytes
- Can cause air in layers
- Air in portal vein (tree)
Stress ulcer
Stomach ulcer 0.5-1d after stress
Coagulation disorder
- Kids w/ melena & Hematemesis
- Vit K inj immediately after birth
- Can be congenital
Rare children GI bleed reasons
1- Esophageal varices
2- Esophagitis
3- Meckel’s
4- Lymphonodular hyperplasia
5- Henoch-Schönlein purpura
6- Foreign body
7- AVM
8- HUS
9- IBD
Henoch-Schönlein purpura
- Vasculitis, Medium vessels
Involved systems: - GI, Skin, Joints, Urinary
If all 4 involved (Manifestations): - Hematemesis, Melena
- Petechiae, Purpura (can be in GI)
- Arthralgia, Arthritis
- Hematuria
AVM
Tangle of artery, arteriol, venule and vein
HUS
- Typically after E. Coli diarrhea
- E. Coli toxin causes hemolysis then uremia
- Hematemesis & Melena
Esophageal varices
- In end stage liver disease (chronic hep B, C, autoimmune hepatitis)
- Portal vein hypertension
- Splenomegaly
- Retro-peritoneal Varices
- Anal hemorrhoid
Hematemesis approach
- Emergency
- If we’re sure it’s blood from GI then:
- Diagnosis
- Gastric lavage
- IV & serum
- Blood cross match
- Pressure stabilization
- Endoscopy
- If nothing: epistaxis, maternal, allergy
Melena approach
The upper the problem the blacker it gets
- If bloody diarrhea: Colitis
- Colitis: Bacterial, IBD, inflammation
- Colonoscopy
- Meckel’s diverticulum scan
- RBC scan (radioactive) then angiography
GI blood supply
- Celiac: Esophagus, stomach, beginning of small intestine
- Superior mesenteric: Small intestine, beginning of large
- Middle mesenteric: Transverse colon to end
Hematemesis & Melena together approach
- First endoscopy
- If nothing, Colonoscopy
- Bright red from beginning: Colonoscopy
- If nothing, Meckel’s scan
- If nothing, RBC scan, selective angiography, surgery
