GI Bleeding

Question 0

Causes of UGIB

Answer 0

Causes of UGIB

Ulcers -Most common
Varices
Mallory-Weiss tears
Gastroduodenal erosions
Erosive esophagitis
Neoplasm
Vascular ectasias
Esophageal varices
Hemorrhagic and erosive gastropathy (“gastritis”)

Other less frequent causes of UGIB include erosive duodenitis, neoplasms, aortoenteric fistulas, vascular lesions [includ- ing hereditary hemorrhagic telangiectasias (Osler-Weber-Rendu) and gastric antral vascular ectasia (“watermelon stomach”)], Dieulafoy’s lesion (in which an aberrant vessel in the mucosa bleeds from a pin- point mucosal defect), prolapse gastropathy (prolapse of proximal stomach into esophagus with retching, especially in alcoholics), and hemobilia or hemosuccus pancreaticus (bleeding from the bile duct or pancreatic duct). Other causes

Question 1

Differentiate

• Hematemesis
• Melena
• Hematochezia

Answer 1

Hematemesis is vomitus of red blood or “coffee-grounds” material.

Melena is black, tarry, foul-smelling stool.

Hematochezia is the passage of bright red or maroon blood from the rectum.

Question 2

Classic History of Mallory-Weiss Tear

Answer 2

classic history is vomiting, retching, or coughing preceding hematemesis, especially in an alcoholic patient. Mallory-Weiss tears

Question 3

Common causes of Small Intestinal Bleeding

Answer 3

Fortunately, small-intestinal bleeding is uncommon. The most common causes in adults are vascular ectasias, tumors (e.g., adenocarcinoma, leiomyoma, lymphoma, benign polyps, carcinoid, metastases, and lipoma), and NSAID-induced erosions and ulcers. Other less common causes in adults include Crohn’s disease, infec- tion, ischemia, vasculitis, small-bowel varices, diverticula, Meckel’s diverticulum, duplication cysts, and intussusception.

Question 4

Most common cause of LGIB (small intestines)

Answer 4

Meckel’s Diverticulum in children

small-bowel tumors often account for obscure GIB In adults 50–60 years

Question 5

Causes of LGIB (Colonic)

Answer 5

Causes of LGIB (Colonic)

• Hemorrhoids - most common
• Anal fissures
• diverticula, vascular ectasias (especially in the proximal colon of patients >70 years), neoplasms (primarily adenocarcinoma), and colitis—most commonly infec- tious or idiopathic inflammatory bowel disease, but occasionally ischemic or radiation-induced
• Uncommon causes include post- polypectomy bleeding, solitary rectal ulcer syndrome, NSAID- induced ulcers or colitis, trauma, varices (most commonly rectal), lymphoid nodular hyperplasia, vasculitis, and aortocolic fistulas. In children and adolescents, the most common colonic causes of sig- nificant GIB are inflammatory bowel disease and juvenile polyps.

Question 6

Differentiation of Upper and Lower GIB

Answer 6

Hematemesis indicates an upper GI source of bleeding (above the ligament of Treitz).

Melena indicates that blood has been present in the GI tract for at least 14 h (and as long as 3–5 days)

Hematochezia usually represents a lower GI source of bleeding

Other clues to UGIB include hyperactive bowel sounds and an elevated blood urea nitrogen level (due to volume depletion and blood proteins absorbed in the small intestine)

Question 7

Fecal occult blood testing is recommended only for

Answer 7

• colorectal cancer screening
• may be used in average-risk adults (beginning at age 50)
• in adults with a first-degree relative with colorectal neoplasm at ≥60 years or two second-degree relatives with colorectal cancer (beginning at age 40)