GI Bleeding

Question 1

Type of bleeding

Answer 1

• Upper: Hematemesis
• Lower: Melena
• Rectorrhagia = bright red rectal bleeding

Question 2

Upper & Melena

Answer 2

1- Very little bleed
2- 1st & 2nd part of duodenum but pylor spasm

Question 3

Infant (29d - 1yr)GI bleed reasons

Answer 3

1- Bacterial enteritis
2- Milk protein allergy
3- Intussusception
4- Maternal blood
5- Anal fissure
6- Lymphonodular hyperplasia

Question 4

Bacterial enteritis

Answer 4

• Bloody diarrhea
• Shigella, Yersinia, Helicobacter, E. Coli, Salmonella, Amoeba

Question 5

Milk protein allergy

Answer 5

Most common: Bloody stool w/o diarrhea
- Resolves til 1yr
- No complaints (kid) except bloody stool
- Diet milk (if baby formula)

Question 6

Intussusception

Answer 6

• Different places and names
• No Peristalsis
• 3m-3y Idiopathic
• <3m or >3y needs lead point (polyp, submucosal bleed, intestinal lymphoma)

Question 7

Intussusception causes _____

Answer 7

• Hyperemia
• Venous Return problem
• Blood and fluid goes to intestine
• Artery obstruction (Very Painful)

Question 8

Intussusception clinical manifestations

Answer 8

• Sudden crying then calming down then crying again after 1-2h
• Increasing frequency
• Telephone
• Hard stomach
• Can be touched in RUQ

Question 9

Maternal Blood

Answer 9

• 1-2h after birth
• Nipple fissure

Question 10

Lymphonodular hyperplasia

Answer 10

Allergy
- لبنیات، تخم مرغ، مغزیجات، ماهی و دریایی، سویا، کنجد
- In colonoscopy

Question 11

Children GI bleed reasons

Answer 11

1- Bacterial enteritis
2- Anal fissure
3- Colonic polyps
4- Intussusception
5- Peptic disease
6- Swallowed epistaxis
7- Mallory-weiss syndrome

Question 12

Colonic polyps

Answer 12

• Bleeding & pain
• Can cause obstruction & intussusception
• Diagnosis & treatment = colonoscopy, polypectomy

Question 13

Peptic disease

Answer 13

Stomach acid on stomach or duodenum mucous
- Gastric or duodenal + Inflammation, Erosion, Ulcers
- Food related (better or worse)
- Epigastric
Treatment = PPI (-prazole)

Question 14

Mallory-Weiss syndrome

Answer 14

• Esophagus tear
• Forceful retching
• Distal esophagus

Question 15

Teen GI bleed reasons

Answer 15

1- Bacterial enteritis
2- IBD
3- Peptic disease
4- Mallory-weiss
5- Colonic polyps

Question 16

IBD

Answer 16

Ulcerative colitis (1), Crohn’s (2)
Differences
- (1)just large intestine, (2) whole GI
- (1) single ulcer, (2) multiple
- (1) mucus and submucosal layer, (2) all layers so fistula
- (1) goes up from rectum

Question 17

Rare infancy GI bleed reasons

Answer 17

1- Volvulus
2- Meckel diverticulum
3- NEC (Necrotizing EnteroColitis)
4- Stress ulcer
5- Coagulation disorders

Question 18

Volvulus

Answer 18

• Intestine twist around itself
• Sigmoid
• Bloody stool

Question 19

Meckel diverticulum

Answer 19

• Most common congenital GI anomaly
  2 rule
• 2% of people
• 2 foot from ileocecal
• 2 inch max
• 2 out-of-place tissues (stomach, pancreas)
• 2 problems (bleeding, perforation)
• Onfalomesentrico (in open, out closed)
• Can mimic appendicitis
• Has stomach tissue so acid

Question 20

NEC

Answer 20

• Premature, NICU, High calorie, Sepsis
• Small bleeding ulcers
• Typic = sepsis + blood from rectum
• Treatment = Ab + Electrolytes
• Can cause air in layers
• Air in portal vein (tree)

Question 21

Stress ulcer

Answer 21

Stomach ulcer 0.5-1d after stress

Question 22

Coagulation disorder

Answer 22

• Kids w/ melena & Hematemesis
• Vit K inj immediately after birth
• Can be congenital

Question 23

Rare children GI bleed reasons

Answer 23

1- Esophageal varices
2- Esophagitis
3- Meckel’s
4- Lymphonodular hyperplasia
5- Henoch-Schönlein purpura
6- Foreign body
7- AVM
8- HUS
9- IBD

Question 24

Henoch-Schönlein purpura

Answer 24

• Vasculitis, Medium vessels
  Involved systems:
• GI, Skin, Joints, Urinary
  If all 4 involved (Manifestations):
• Hematemesis, Melena
• Petechiae, Purpura (can be in GI)
• Arthralgia, Arthritis
• Hematuria

Question 25

AVM

Answer 25

Tangle of artery, arteriol, venule and vein

Question 26

HUS

Answer 26

- Typically after E. Coli diarrhea - E. Coli toxin causes hemolysis then uremia - Hematemesis & Melena

Question 27

Esophageal varices

Answer 27

- In end stage liver disease (chronic hep B, C, autoimmune hepatitis) - **Portal vein hypertension** - Splenomegaly - Retro-peritoneal Varices - Anal hemorrhoid

Question 28

Hematemesis approach

Answer 28

- Emergency - If we're sure it's _blood_ from _GI_ then: - Diagnosis - Gastric lavage - IV & serum - Blood cross match - Pressure stabilization - Endoscopy - If nothing: epistaxis, maternal, allergy

Question 29

Melena approach

Answer 29

**The upper the problem the blacker it gets** - If bloody diarrhea: Colitis - Colitis: Bacterial, IBD, inflammation - Colonoscopy - Meckel's diverticulum scan - RBC scan (radioactive) then angiography

Question 30

GI blood supply

Answer 30

- **Celiac:** Esophagus, stomach, beginning of small intestine - **Superior mesenteric:** Small intestine, beginning of large - **Middle mesenteric:** Transverse colon to end

Question 31

Hematemesis & Melena together approach

Answer 31

- First endoscopy - If nothing, Colonoscopy - Bright red from beginning: Colonoscopy - If nothing, Meckel's scan - If nothing, RBC scan, selective angiography, surgery