GI Bleeding
GI Bleeding
GI Bleeding
NICKLAUS RIVERA
YL8
CASE
70
yo, M
CC:
rectal bleeding
HPI:
(+)
No
Had
GI Bleeding Presentation
Hematemesis
Melena
Hematochezia
Occult
GIB
Symptoms
Approach
UGIB
vs LGIB
Ligament
of Treitz
BUN
Bowel
sounds
Sources
Upper
GI
Small intestine
Colonic
Upper GI
Sources of Bleeding
Proportion of Patients, %
Ulcers
31-59
Varices
7-20
Mallory-Weiss tears
4-8
Gastroduodenal erosions
2-7
Erosive esophagitis
1-13
Neoplasm
2-7
Vascular ectasias
0-6
No source identified
8-14
Upper GI
Peptic
Most
Ulcers
Peptic Ulcers
Features
Dyspepsia
Most
Pain
Pain
Peptic Ulcers
Features
Asymptomatic
70%
Peptic Ulcers
Features
Bleeding
Nausea,
In
hematemesis, melena
Peptic Ulcers
Features
Gastric
Early
obstruction
Peptic Ulcers
Features
Perforation
Duodenal
Antral
60%
20%
Gastric
20%
Peptic Ulcers
Features
Penetration
Referred
Peptic Ulcers
Features
Fistulization
Halitosis,
Peptic Ulcers
Features
Associated
symptoms
Gastroesophageal
reflux 46%
Peptic Ulcers
Causes
H.
pylori
NSAIDs
Acid
Mallory-Weiss Tears
Longitudinal
Mallory-Weiss Tears
Features
History
of retching
Vomiting
Coughing
preceding hematemesis
Mallory-Weiss Tears
Causes
Alcoholism
2
Hiatal
hernia
Esophageal Varices
Dilated
Poorer
blood vessels
Esophageal Varices
Features
Melena
Low
BP
Rapid
HR
Symptoms
visualized subepithelial
hemorrhages and erosions
Mucosal
NSAIDs
Alcoholism
Stress
Erosive
duodenitis
Neoplasms
Aortoenteric
Vascular
lesions
Dieulafoy's
Prolapse
fistulas
lesion
gastropathy
Hemobilia
Sources
Upper
GI
Small intestine
Colonic
Vascular
Tumor
ectasia
Crohn's
disease
Infection
cyst
Intussusception
Vasculitis
Diverticula
diverticulum
Duplication
Ischemia
Small-bowel
Meckel's
varices
NSAIDs
By
age group
Children
Meckels diverticulum
<
>
Sources
Upper
GI
Small intestine
Colonic
Hemorrhoids
Anal
fissures
Diverticula
Vascular
ectasias
proximal
Neoplasms
primarily
Colitis
adenocarcinoma
Post-polypectomy
Varices
Solitary
Lymphoid
NSAID-induced
Vasculitis
bleeding
rectal ulcer
syndrome
ulcers or colitis
Trauma
(most
commonly rectal)
nodular
hyperplasia
Aortocolic
fistulas
Inflammatory
Juvenile
bowel disease
polyps
Approach
Measure
Bowel
HR and BP
sounds
Hemoglobin
BUN
Approach
Endoscopy
and
Colonoscopy/Sigmoidoscopy
Barium
Arteriography
Radio
isotope scanning