Advertisement
 

doctorslounge.com

 
Powered by
Careerbuilder

 

                    Home  |  Forums  |  Humor  |  Advertising  |  Contact
   Ask a Doctor

   News via RSS

   Newsletter

   Gastroenterology

   News

 

 Conferences


   CME

   Forum Archives

   Diseases

   Symptoms

   Labs

   Procedures

   Drugs

   Links
   Specialties

   Cardiology

   Dermatology

   Endocrinology

   Fertility

   Gastroenterology

   Gynecology

   Hematology

   Infections

   Nephrology

   Neurology

   Oncology

   Orthopedics

   Pediatrics

   Pharmacy

   Primary Care

   Psychiatry

   Pulmonology

   Rheumatology

   Surgery

   Urology

   Other Sections

   Membership

   Research Tools

   Medical Tutorials

   Medical Software

 

 Headlines:

 
 

Gastrointestinal bleeding

1. Hematemesis

Definition

Hematemesis is vomiting of gross blood. It is diagnostic of bleeding from any site proximal to the ligament of Treitz.

Assessment

  1. resuscitation
  2. nasopharyngeal tube
  3. lab assessment
  4. endoscopy within 48hrs
  5. medical therapy / surgery

Sources of hematemesis

  • Esophagus
    •   Esophagitis
    •   Ulcer
    •   Mallory-Weiss tear
    •   Esophageal varices
  • Stomach
    •   Gastric ulcer
    •   Prepyloric ulcer
    •   Pyloric channel ulcer
    •   Gastric erosions
    •   Gastritis
    •   Varices
    •   Portal-hypertensive gastropathy
    •   Gastric cancer
    •   Polyp
    •   Dieulafoy lesion
  • Duodenum
    •   Ulcer
    •   Duodenitis
    •   Aortoenteric fistula
    •   Pancreatic pseudocyst
    •   Post-sphincterotomy

Melenemesis, or "coffee grounds" vomiting, occurs when blood is in contact with gastric acid for at least 1 hour.

advertisement.gif (61x7 -- 0 bytes)
 

Are you a doctor or a nurse?

Do you want to join the Doctors Lounge online medical community?

Participate in editorial activities (publish, peer review, edit) and give a helping hand to the largest online community of patients.

Click on the link below to see the requirements:

Doctors Lounge Membership Application



2. Melena

Definition

The passage of dark black, liquid, tarry, metallic-smelling stools. Melenic stools usually indicate bleeding proximal to the right side of the colon. It usually indicates that hemorrhage has remained for > 8hrs in the GI tract.

Assessment

Assessment depends on whether the patient is actively bleeding or if the bleeding has stopped.

  1. Actively bleeding patients:
    1. UGI endoscopy
    2. arteriography
    3. scan
  2. If not bleeding:
    1. endoscopy
    2. elective colonoscopy

Sources of melena

  • All causes of upper gastrointestinal bleeding
  • Jejunum and ileum: (Meckel's diverticulum, angiodysplasia, Chron's disease, tumors, bowel infarction).
  • Colon: right sided tumors, angiodysplasia, inflammatory bowel disease.

3. Blood intermixed with stools

Results when the source of bleeding arises from the colon.

Assessment includes colonoscopy

Sources of bleeding


4. Hematocezia

Definition

The passage of bright red stools. Is usually indicative of bleeding from the rectum & anus, however 50% are due to proximal lesions (mainly in the colon) that are profuse enough that they avoid remaining in the gut for 8hrs & are not expressed as blood intermixed with stools.

Assessment

Assessment includes PR examination if nothing is found then order an anoscopy, proctosigmoidoscopy and lastly colonoscopy.

Sources of hematocezia

  • Colonic cancer
  • Colonic polyps
  • Diverticula
  • Colitis
  • Vascular ectasia
  • Large hemorrhoids only
  • Ulcer tear (rectum)
  • Upper gastrointestinal or small bowel source
  • No site identified

5. Occult blood in stools

The use of this lab test is limited to premenopausal woman with anemia and no history of menorrhagia. Or as a screening test for large bowel malignancy. It should not be used as the investigation that determines the cause of <a href="../../diagnosis/anemia/index.htm">anemia</a> in men / postmenopausal women as in these cases the cause is almost always due to GI cause even if FOBT is negative. In such cases FOBT is a useful indicator to whether the cause could be in the lower GIT (FOBT positive) or in the upper GIT (FOBT negative).

Assessment includes:

  • history and exam to suggest the most likely site of bleeding.
  • colonoscopy is done before UGI endoscopy in the same session..(barium enema if colonoscopy not available) --> small bowel follow through although the diagnostic yield is low. enteroscopy may be needed. Arteriography.
  • ANY POSSIBLE LESIONS ARE BIOPSIED.

Source of bleeding

1. Occult Bleeding with Signs of Upper Gastrointestinal Hemorrhage

  • Epistaxis
  • Hemoptysis
  • Gingival/glossal/pharyngeal bleeding
  • Ingestion of blood--human or animal
  • Gastric cardia varices
  • Antral/duodenal varices
  • Dieulafoy lesions
  • Pancreaticobiliary bleeding
    •   Pancreatic pseudoaneurysm
    •   Hepatic neoplasms/trauma
  • Aortoduodenal fistula
  • Duodenal diverticulum
  • Vascular ectasias

2. Occult Bleeding with Signs of Lower Gastrointestinal Hemorrhage

  • Briskly bleeding duodenal ulcers
  • Small bowel Dieulafoy lesions
  • Vascular ectasias of colon
  • Meckel's diverticulum--distal ileum
  • Aortocolonic or arteriocolonic fistula
  • Solitary colonic ulcers
  • Colorectal varices

3. Blood Loss without Signs/Symptoms of Either Upper or Lower Bleeding

  • Small bowel neoplasms
    •   Adenocarcinoma
    •   Sarcoma, leiomyoma
    •   Lymphoma
    •   Metastases--breast, lung, melanoma
  • Vascular ectasias
  • Crohn's disease of small bowel
  • Dieulafoy lesions
  • Small bowel varices

6. Chronic GIT bleeding causing anemia

Assessment includes:

  1. history and exam to suggest the most likely site of bleeding.
  2. colonoscopy is done before UGI endoscopy in the same session (barium enema if colonoscopy not available) if the FOBT is positive, otherwise if negative then endoscopy should precede colonoscopy.
  3. small bowel follow through although the diagnostic yield is low.
  4. enteroscopy may be needed.
  5. Arteriography.
  6. ANY POSSIBLE LESIONS ARE BIOPSIED.

Sources of bleeding

  • Colon
    •   Cancer
    •   Polyp
    •   Vascular ectasia
    •   Colitis
    •   Cecal ulcer
    •   Parasites
  • Upper gastrointestinal tract
    •   Duodenal ulcer
    •   Esophagitis
    •   Gastritis
    •   Gastric ulcer
    •   Vascular ectasia
    •   Anastomotic ulcer
    •   Gastric cancer
    •   Portal hypertensive gastropathy
    •   Adenomatous polyp

 


previous.gif (72x17 -- 347 bytes) next.gif (72x17 -- 277 bytes)
 

 advertisement.gif (61x7 -- 0 bytes)

 

 



We subscribe to the HONcode principles of the HON Foundation. Click to verify.
We subscribe to the HONcode principles. Verify here

Privacy Statement | Terms & Conditions | Editorial Board | About us
Copyright 2001-2012 DoctorsLounge. All rights reserved.