GIT Bleeding
Hematemesis this is vomiting blood or a brownish black semi granular substance often
described as being like coffee grounds which is what blood looks like after sinning in the acidic
environment of the stomach for a while.
Hematochezia is the passage of visible bright red or maroon colored blood in the stool.
BRBPR which stands for bright red blood per rectum which can be thought of as an easier to
spell near synonym for hematochezia.
Melena is black tar e foul-smelling stool that is the consequence of stool containing digested
blood.
Occult bleeding refers to bleeding without the presence of symptoms in other words the blood
loss is either so small or so gradual that the patient doesn't realize it because there still hasn't
visibly changed.
Esophagitis can be the result of fungal or viral instructions and poorly controlled gastro
esophageal reflux disease.
Esophageal varices are dilated venous collaterals that connect the portal and systemic
venous systems this is seen most commonly in cirrhosis.
Dieulafoy’s lesion which is a single tortuous arterial in the gastric mucosa that is
systelogically normal but of an unusually large diameter and which can spontaneously
rupture.
Duodenitis caused by either infectious or non-infectious pathology.
Angiodysplasia are vascular lesions which are focal collections of dilated thin walled veins
that are separated from the lumen by endothelium alone a common synonym for
angiodysplasia is arterial venous malformation or AVM.
Entero-invasive infections such as some strains of E coli.
Diverticulosis a condition in which a focal weakening of the colonic wall leads to small
pouches known as diverticula if they become infected the condition is called diverticulitis
and when they bleed it's just called a diverticular bleed while diverticular bleeds and
diverticulitis can occur in the same patient over time they only rarely occur simultaneously.
Ischemic colitis result from either shock and embolus or atherosclerosis of the mesenteric
vessels.
significant group of ideologies are those associated with cirrhosis and portal hypertension
this includes esophageal and gastric varices portal hypertensive gas Tripathy and gastric
antral vascular ectasias
Most common causes of Upper gastrointestinal tract
1. Chronic peptic ulcer: duodenal ulcer, gastric ulcer.
2. Acute peptic ulcer (erosions).
Most common causes of Lower gastrointestinal tract
1. Angiodysplasia.
2. Diverticular disease.
3. Colonic carcinoma or polyp.
4. Haemorrhoids or anal fissure.
Alcohol and smoking both increase the risk of various GI malignancies and alcohol itself can
lead to gastritis and even mallory-weiss tears if the patient is frequently vomiting and retching
related to their intoxication
Guaic test is a bedside test that detects the presence of microscopic amounts of heme in the
stool it's performed by applying a small amount of stool to a standardized card to which a
reagent is applied. The development of a blue color indicates heme.
patients with an acute bleed of any cause will not immediately cause a drop in hemoglobin
and hematocrit.
EGD = OGD
Obscure GI bleeding there are two possibilities here one the lesion could have stopped
bleeding and is small enough that it was missed during conventional endoscopy or two the
lesion is somewhere in the small bowel that conventional endoscopy can't reach
If you have reason to think the former you could repeat the EGD and/or colonoscopy or
you could just observe the patient closely and hope the bleeding doesn't recur
If bleeding is hidden somewhere in the small intestines you have a number of choices you
could get a CT angiogram of the abdomen and pelvis, something called a push and
enteroscopy which involves taking a specialized endoscope
introduced through the mouth and advancing it much farther down
the GI tract, a tagged RBC scan which is a test performed by
nuclear medicine in which a small amounts of a patient's blood is
removed and red blood cells are radio labeled and then returned to
the circulation radio sensitive images are then taken to see if the
bleeding can be localized to a quadrant of the abdomen. Fuzzy's
mess is the typical quality of the image that you get, the major
disadvantages of the study is that it tells you nothing about the
cause and can't even conclusively tell you which organ the blood is
coming from and the last option is a capsule endoscopy which the patient swallows a pill
large enough to contain the camera which takes pictures continuously as it passes through
the GI tract and is eventually eliminated with a bowel movement.
