Medical Archive

Introduction

Sources of gastrointestinal bleeding

Upper gastrointestinal sources of bleeding

Peptic ulcers

Mallory-Weiss tears

Esophageal varices

Erosive disease

Other causes

Small-intestinal sources of bleeding

Colonic sources of bleeding

Approach to the patient

Initial assessment

• Melena
  • Gastric lavage: 16%?? ???
  • EGD to r/o hemorrhage in duodenum
• ??? ? ? ?? GI bleeding
  • Mild-moderate
    • Capsule endoscopy
    • RBC scan
  • Severe, persistent
    • Angiography -> intraop. endoscopy

Differentiation of UGIB from LGIB

Evaluation and management of UGIB

Admission Marker		Score
Blood urea nitrogen (mg/dL)	18.2 to <22.4	2
	22.4 to <28.0	3
	28.0 to <70.0	4
	?70.0	6
Hemoglobin (g/dL)	12.0 to <13.0 (men); 10.0 to <12.0 (women)	1
	10.0 to <12.0 (men)	3
	<10.0	6
Systolic blood pressure (mmHg)	100–109	1
	90–99	2
	<90	3
Heart rate (beats per minute)	?100	1
Other markers	Melena	1
	Syncope	2
	Hepatic disease	2
	Cardiac failure	2

Management

• Non-variceal upper GI bleeding
  • Endoscopic bleeding control
  • If rebleeding, repeat endoscopic bleeding control.
  • If bleeding still continues, surgical approach (eg., ???? ?? ? ?? ???)
• Variceal hemorrhage
  1. Place 2 large-bore IV catheters
  2. Volume resuscitation, IV octreotide, antibiotics
  3. Urgent endoscopy within 12 hours
     • Can diagnose and treat active bleeding (eg, band ligation, sclerotherapy)
  4. Uncontrollable bleeding
     1. Require temporary balloon tamponade (eg, Sengstaken-Blakemore, Minnesota, Linton-Nachlas tubes)
     2. Definitive therapy; TIPS or shunt surgery

Evaluation and management of LGIB

# Radiation proctitis

With chronic radiation proctitis, as the rectum becomes progressively fibrotic, it stiffens, and storage of stool becomes difficult d/t impaired rectal compliance, leading to urgency and fecal incontinence.
Chronic tissue hypoxia results in neovascularization and telangiectasia formation, which are prone to bleeding and may result in hematochezia.

Evaluation and management of small-intestinal or obscure GIB

Positive fecal occult blood test