Obsecure Git Bleeding

Question 1

Types

Answer 1

1-obscure-overt (visible signs like melena or hematochezia) 2-obscure-occult (positive fecal occult blood test or iron deficiency anemia without visible blood).

Question 2

Causes

Answer 2

Mnemonic: “AV DIM GUT”

A V D I M G U T – covers major causes of small bowel bleeding:

A – Angiodysplasia / Angioectasia

V – Vascular lesions (including GAVE, Dieulafoy’s lesion)

D – Diverticulum (Meckel’s)

I – Inflammatory bowel disease (Crohn’s)

M – Malignancy (GIST, lymphoma, adenocarcinoma)

G – Granulomatous diseases / Graft-versus-host disease

U – Ulcers (NSAID-induced)

T – Telangiectasias / Tumors / Tuberculosis

Question 3

Diagnosis

Answer 3

After negative EGD and colonoscopy, further evaluation typically includes:

1. Repeat endoscopy/colonoscopy (if initial exams were incomplete)
2. Capsule endoscopy – non-invasive and first-line for small bowel visualization
3. Deep enteroscopy (e.g., double-balloon or single-balloon enteroscopy)
4. CT enterography / MR enterography – for tumors or inflammatory disease
5. Tagged RBC scan – if active bleeding suspected
6. Angiography – if bleeding is active and rapid
7. Meckel’s scan – especially in younger patients

Question 4

Management

Answer 4

Depends on the underlying cause, but general strategies include:

Endoscopic therapy (cautery, clip placement, argon plasma coagulation)

Medical management:

Iron supplementation for anemia

Octreotide (for vascular lesions, especially in recurrent bleeds)

Discontinue NSAIDs and anticoagulants if possible

Surgery – if a resectable lesion is found or persistent/recurrent bleeding

Angiographic embolization – for active, localized bleeding

Interventional radiology – in selected cases