DDx: Gastrointestinal Bleeding Flashcards Preview

03 GI AND HEPATOLOGY > DDx: Gastrointestinal Bleeding > Flashcards

Flashcards in DDx: Gastrointestinal Bleeding Deck (18):
1

Common Causes of Gastrointestinal Bleeding: upper GI tract

 

 

Gastric and duodenal ulcers

Variceal bleeding

Mallory-Weiss tear

Esophagitis

Gastritis or gastroduodenal erosions

Esophageal or gastric cancer

Studies: CBC, PTT, INR, CMP. EGD (upper endoscopy),

Melena - 14 hours

Obscure: 

Cameron erosion - Large hiatal hernia

NSAID ulcerations - Medication review

Dieulafoy lesion - intermittend karge volume

Crohn disease - manifestations

Gastric antral vascular ectasia - female; autoimmune

 

2

Gastric and duodenal ulcers

Dyspepsia, Helicobacter pylori infection, NSAID use, anticoagulation, severe medical illness

Dx: PPI before EGD

3

Variceal bleeding

Stigmata of chronic liver disease on examination and evidence of portal hypertension or risk factor for cirrhosis (heavy alcohol use, viral hepatitis).

Tx: Endoscopic Band Ligation; octreotide

4

Mallory-Weiss tear

Retching before hematemesis

5

Esophagitis

Heartburn, regurgitation, dysphagia; usually small-volume or occult bleeding

6

Gastritis or gastroduodenal erosions

NSAID use, heavy alcohol use, severe medical illness; usually small-volume or occult bleeding

7

Esophageal or gastric cancer

Progressive dysphagia, weight loss, early satiety, abdominal pain; usually small-volume or occult bleeding

8

Common Causes of GI bleeding: Lower Gastrointestinal Tract:

Occult bleeding is defined as clinically suspected bleeding without overt signs of blood loss (for example, in a patient with anemia and positive fecal occult blood testing). Many patients with obscure gastrointestinal bleeding have sources in the small intestine between the ligament of Treitz and the ileocecal valve, sometimes referred to as “mid-gastrointestinal bleeding.”

The presence of melena (black, tarry stools) suggests an upper gastrointestinal tract source but can be associated with loss of as little as 150 to 200 mL of blood. Hematemesis of bright red blood is associated with ongoing upper gastrointestinal bleeding, whereas hematochezia secondary to an upper gastrointestinal source is suggestive of brisk ongoing bleeding of at least 1000 mL of blood. 

Diverticula

Angiectasias or angiodysplasia

Colonic polyp

Colon cancer

Ischemic colitis

Acute small bowel (mesenteric) ischemia

Hemorrhoids

Infectious colitis

Inflammatory bowel disease

Meckel diverticulum

Dx: Colonoscopy

Alternative: technetium 99m pertechnetate–labeled red blood cell scan or angiography; enteroscopy

Obscure:

Angiectasias - Intermittent, usually occult bleeding; may also occur in colon

Peutz-Jeghers syndrome - Perioral pigmentation, obstructive symptoms

Meckel diverticulum - Possible abdominal pain

Hemangioma - Possible cutaneous hemangiomas

Malignancy - Weight loss, abdominal pain

Hereditary hemorrhagic telangiectasia - Facial telangiectasias

 

9

Diverticula

Bleeding is arterial, resulting from medial thinning of the vasa recta as they drape over the dome of the diverticulum. Generally, patients do not have other symptoms. Physical Examination is usually unremarkable unless large blood loss results in tachycardia, hypotension, and orthostasis. Colonoscopy may identify the bleeding diverticulum and permit endoscopic treatment with epinephrine and/or electrocautery; colonoscopy may also help identify other causes of bleeding such as vascular ectasias. Vascular ectasias or angiodysplasias (erroneously called arteriovenous malformations) account for up to 11% of episodes of lower gastrointestinal bleeding. They are painless dilated submucosal vessels that radiate from a central feeding vessel. Patients may present with iron deficiency anemia and occult gastrointestinal bleeding or with hematochezia that is indistinguishable from diverticular hemorrhage.

Painless, self-limited hematochezia.

Tx: endoscopic electrocautery

10

Angiectasias or angiodysplasia

Angiectasia is the most common cause of small intestinal bleeding in the elderly, accounting for up to 80% of cases. 

Chronic blood loss or acute painless hematochezia in elderly individual; frequently involves upper GI tract in addition to colon

11

Colonic polyp

Usually asymptomatic; stool may be positive for occult blood

12

Colon cancer

Age >50 y and usually asymptomatic; change in bowel pattern or microcytic anemia

13

Ischemic colitis

Risk factors for atherosclerosis and evidence of vascular disease in elderly individual; abdominal pain.

Tx: IV fluids; pain control; angiography, laprotomy

14

Acute small bowel (mesenteric) ischemia

Severe abdominal pain out of proportion to physical findings; atherosclerotic or embolic risk factors; anion gap metabolic acidosis; bleeding a late finding

15

Hemorrhoids

Intermittent mild rectal bleeding associated with straining on bowel movement

Hx: Streaks of bright red blood on the toilet paper or on the outside of a firm stool. 

Dx: Digital rectal exam; anoscopy

16

Infectious colitis

Bloody diarrhea, fever, urgency, tenesmus; exposure history

17

Inflammatory bowel disease

History of condition and bloody diarrhea, tenesmus, abdominal pain, fever, extracolonic symptoms

18

Meckel diverticulum

Painless hematochezia in a young patient; normal EGD and colonoscopy