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Gastrointestinal Hemorrhage

Gastrointestinal Tract Hemorrhage


Presentation

  • Abstract This unique case reports the first recorded episode in the medical literature of vasculitis post-liver transplantation, presenting as life-threatening gastrointestinal hemorrhage.[ncbi.nlm.nih.gov]
  • Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage.[ncbi.nlm.nih.gov]
  • METHODS: We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals.[ncbi.nlm.nih.gov]
  • The present case indicates that gastrointestinal manifestations might thus be considered in the natural history of WG.[ncbi.nlm.nih.gov]
  • ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6.[ncbi.nlm.nih.gov]
Splenomegaly
  • This is often due to pre-existing liver disease and splenomegaly.[geekymedics.com]
  • Other signs to look for are ascites and erythema (chronic liver disease) and splenomegaly and dilated abdominal wall veins (portal hypertension).[uspharmacist.com]
  • External stigmata of bleeding disorders (eg, petechiae, ecchymoses) are sought, as are signs of chronic liver disease (eg, spider angiomas, ascites, palmar erythema) and portal hypertension (eg, splenomegaly, dilated abdominal wall veins).[merckmanuals.com]
Anemia
  • Although severe anemia can theoretically result in anemic hypoxia, vulnerable pallidal lesions have rarely been described in anemic patients.[ncbi.nlm.nih.gov]
  • Abstract A 59-year-old female patient was hospitalized with anemia from recurrent gastrointestinal bleeding.[ncbi.nlm.nih.gov]
  • In September 2005, the patient was admitted with worsening anemia. Computed tomography and upper gastrointestinal endoscopy revealed that the HCC had directly invaded the stomach and caused gastrointestinal hemorrhage.[ncbi.nlm.nih.gov]
  • We report a case of a 66-year-old male with a history of G.I. hemorrhage and acute anemia, negative upper and lower endoscopies and a pedunculated lipoma in distal ileum, revealed by CT enterography.[ncbi.nlm.nih.gov]
  • Surgical resection was performed due to persistent, symptomatic anemia. The patient is free of recurrent hemorrhage at 24months after metastectomy.[ncbi.nlm.nih.gov]
Fever
  • RESULTS: Among 175 patients with GI bleeding, dengue hemorrhagic fever was found in 119 (68%) patients; the median duration from onset dengue illness to GI bleeding was 5 days.[ncbi.nlm.nih.gov]
  • These include: The area around your wound is more red or painful Your wound area is very warm to touch You have a fever higher than 101.5 F (38.6 C) You have blood, pus, or other fluid coming from the wound area You have chills or muscle aches Developed[summitmedicalgroup.com]
  • […] vessel rupture as a result of high blood pressure, aneurysms, esophageal varices, peptic ulcers, or ectopic pregnancy. [6] Other diseases linked to internal bleeding include cancer, hematologic disease, Vitamin K deficiency, and rare viral hemorrhagic fever[en.m.wikipedia.org]
  • In the United States, Salmonella, Shigella, and Campylobacter are the most common causative pathogens; such microbial agents cause an inflammatory diarrhea characterized by fever, bloody diarrhea, lower quadrant cramps, and tenesmus.[emedicine.medscape.com]
  • Stallmach , Recurrent fever and bacteraemia after endoscopic variceal haemostasis with cyanoacrylate: a case report , Infection , 40 , 3 , (351) , (2012) .[dx.doi.org]
Pallor
  • Seek immediate medical care (call 911) for serious symptoms, pale skin or pallor and difficulty breathing, severe abdominal pain , vomiting blood or black material, or change in level of consciousness.[healthgrades.com]
  • . - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of[slideshare.net]
  • Physical examination showed tachycardia, cutaneomucosal pallor and blood pressure reached 110/60 mm Hg. Before the transference, 5 units of packed red blood cells had been transfused.[scielo.br]
  • General examination focuses on vital signs and other indicators of shock or hypovolemia (eg, tachycardia, tachypnea, pallor, diaphoresis, oliguria, confusion) and anemia (eg, pallor, diaphoresis).[merckmanuals.com]
  • In more severe cases of chronic or acute bleeding, symptoms may include signs of anemia, such as weakness, pallor, dizziness, shortness of breath or angina.[wakegastro.com]
Weight Loss
  • Weight loss and anorexia, with or without a change in stool, suggest a GI cancer. A history of cirrhosis or chronic hepatitis suggests esophageal varices. Dysphagia suggests esophageal cancer or stricture.[merckmanuals.com]
  • “In addition to age, we have to take into account the amount of bleeding, the necessity of blood transfusions, concomitant diseases and associated symptoms like weight loss.[acphospitalist.org]
  • These include presence of abdominal discomfort, weight loss, easy bleeding or bruising, previous colonoscopy results, and symptoms of anemia (weakness, fatigue, dizziness).[uspharmacist.com]
  • loss, smoking, or alcohol consumption; more common in Asians 2 Arteriovenous malformations Painless bleeding in older patients (older than 70 years), history of iron deficiency anemia 10 Esophagitis or esophageal ulcer Heartburn, indigestion, or dysphagia[aafp.org]
  • A targeted history is of value to discern symptoms of unintentional weight loss (suggestive of malignancy), use of aspirin or other NSAIDs (ulcerative mucosal injury), antiplatelet or anticoagulant use, family history, liver disease, and previous gastrointestinal[doi.org]
Familial Adenomatous Polyposis
  • adenomatous polyposis (FAP) Inflammatory Crohn disease Ulcerative colitis Indeterminate colitis Meckel diverticulum Diverticulosis Diverticulosis is the dominant etiology of LGIB, reported as the most common reason for massive LGIB in most single-institution[emedicine.medscape.com]
Dyspnea
  • Younger patients or those with chronic bleeding are usually not transfused unless Hct is 23 or they have symptoms such as dyspnea or coronary ischemia.[merckmanuals.com]
Melena
  • Following recovery from an episode of acute rejection, the patient presented with large volume hematemesis, melena, and hemochezia (passage of fresh blood from the rectum).[ncbi.nlm.nih.gov]
  • We report the case of a 61-year-old woman, who was admitted to our institution with hematemesis and melena. Upper gastrointestinal endoscopy and flexible sigmoidoscopy failed to reveal any significant abnormality.[ncbi.nlm.nih.gov]
  • Melena was also observed throughout the intestine, although clotting was only observed inside the stomach.[ncbi.nlm.nih.gov]
  • Melena was the presenting complaint in 95.06% (578/608) and hematemesis was present in 43.09% (262/608). Both hematemesis and melena were seen in 41.78% (254/608).[tropicalgastro.com]
  • See also coffee-ground vomitus, hematochezia, melena. gastrointestinal bleeding Any hemorrhage into the GI tract lumen, from esophagus–eg, from ruptured esophageal varices, to anus–eg from hemorrhoids gastrointestinal bleeding Bleeding from anywhere in[medical-dictionary.thefreedictionary.com]
Hematemesis
  • Following recovery from an episode of acute rejection, the patient presented with large volume hematemesis, melena, and hemochezia (passage of fresh blood from the rectum).[ncbi.nlm.nih.gov]
  • We report the case of a 61-year-old woman, who was admitted to our institution with hematemesis and melena. Upper gastrointestinal endoscopy and flexible sigmoidoscopy failed to reveal any significant abnormality.[ncbi.nlm.nih.gov]
  • Melena was the presenting complaint in 95.06% (578/608) and hematemesis was present in 43.09% (262/608). Both hematemesis and melena were seen in 41.78% (254/608).[tropicalgastro.com]
  • In each case there was hematemesis as well as tarry stools with the onset of bleeding as early as 24 hours of age to as late as 5 days.[pediatrics.aappublications.org]
Hematochezia
  • The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom.[ncbi.nlm.nih.gov]
  • We report the case of a 35-year-old man who presented with hematuria and hematochezia secondary to an iliac artery-uretero-colonic fistula that developed years after open common iliac artery aneurysm repair.[ncbi.nlm.nih.gov]
  • See also coffee-ground vomitus, hematochezia, melena. gastrointestinal bleeding Any hemorrhage into the GI tract lumen, from esophagus–eg, from ruptured esophageal varices, to anus–eg from hemorrhoids gastrointestinal bleeding Bleeding from anywhere in[medical-dictionary.thefreedictionary.com]
  • The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%.[doi.org]
  • Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia.[ncbi.nlm.nih.gov]
Rectal Bleeding
  • He took one dose of dabigatran 150 mg at 2200 and woke up the following morning before 0900 with profuse rectal bleeding.[ncbi.nlm.nih.gov]
  • Within all the people who go to their doctor with gastrointestinal hemorrhage, 75% report having blood in stool, 68% report having rectal bleeding, and 53% report having sharp abdominal pain.[symcat.com]
  • . : Acute massive rectal bleeding as a presenting sign of Crohn’s disease . N Y State J Med 1988, 88 :545–546. PubMed Google Scholar 12.[link.springer.com]
  • A lower gastrointestinal (GI) hemorrhage, also called lower GI bleeding or rectal bleeding, is abnormal blood loss from the colon, rectum, or anus (the opening of the rectum).[summitmedicalgroup.com]
Gastropathy
  • Other less common causes were erosive gastritis (1.8%), Mallory Weiss tear (1.8%), and retch gastropathy (1.1%). Non steroidal anti inflammatory (NSAID) ingestion was reported in 7.56% of cases. Melena was the commonest mode of presentation.[tropicalgastro.com]
  • […] differences in the pproach to management CAUSES Upper GI Bleeding peptic ulcer disease (75% are gastric, rather than duodenal) Varices (90% are oesophageal, rather than gastric) Oesophagitis Gastritis Duodenitis Mallory-Weiss tears Portal hypertensive gastropathy[lifeinthefastlane.com]
  • ., gastric bypass surgery , Billroth II surgery ) Ingestion of foreign bodies Following interventions such as polypectomy or biopsy Post-surgery anastomotic bleeding Further Portal hypertensive gastropathy Hemorrhoids and anal fissures References: [1][amboss.com]
  • Isabelle Colle, Xavier Verhelst, Anja Geerts and Hans Van Vlierberghe , Varices, portal hypertensive gastropathy and GAVE , Cirrhosis: A practical guide to management , (137-150) , (2015) .[doi.org]
  • Eine medikamentöse vasoaktive Therapie mit einem Vasopressin-Analogon ist bereits beim Verdacht auf eine akute Blutung aus Varizen oder im Rahmen einer portal-hypertensiven Gastropathie indiziert.[thieme-connect.com]
Hypotension
  • Tachycardia and Orthostatic Hypotension . There have been discussions in the literature about other findings to rule in/out upper GI bleeding.[mdedge.com]
  • Rembacken Dealing with upper gastrointestinal (UGI) bleeding is fraught with pitfalls, not least because spotting those patients who are suffering significant bleeding can be difficult amongst the majority of referrals who are ill and hypotensive for[ueg.eu]
  • . - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of[slideshare.net]
  • Byuk Ko, Youn-Jung Kim, Dae Jung, Chang Sohn, Dong Seo, Yoon-Seon Lee, Kyoung Lim, Hwoon-yong Jung and Won Kim , Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin , Journal of Clinical[doi.org]
  • This old patient experienced a period of arterial hypotension, underwent an operation in a critical circumstance, received nine units of packed red blood cells and sustained a wound of great magnitude in the proximity of the major papilla.[scielo.br]
Tachycardia
  • A nasogastric lavage with red blood (summary LR, 3.1; 95% CI, 1.2-14.0), tachycardia (LR, 4.9; 95% CI, 3.2-7.6), or a hemoglobin level of less than 8 g/dL (LR range, 4.5-6.2) increase the likelihood of a severe UGIB requiring urgent intervention.[ncbi.nlm.nih.gov]
  • . - Sometimes, it can be more severe and there may be shallow, eroded areas in the wall of the intestine, along with some bleeding Clinical shock: restlessness, acute hypotension, tachycardia, thready peripheral pulse, pallor, cold clammy skin.Sign of[slideshare.net]
  • Physical examination showed tachycardia, cutaneomucosal pallor and blood pressure reached 110/60 mm Hg. Before the transference, 5 units of packed red blood cells had been transfused.[scielo.br]
  • Circulation Assessment Observations Heart rate – tachycardia can be an early sign of volume depletion Blood pressure – hypotension doesn’t typically occur until there has been significant blood loss (1500-2000mls), so if hypotension is present this is[geekymedics.com]
Orthostatic Hypotension
  • Tachycardia and Orthostatic Hypotension . There have been discussions in the literature about other findings to rule in/out upper GI bleeding.[mdedge.com]
  • Lancet 2009;373:42-7. [ Reference ] Management Medical therapy Resuscitation, ABC including look for orthostatic hypotension etc. Consider transfusion for shock or acute fall in Hb below 7.0 g/dL (below 10.0 if IHD, PVD etc).[lifeinthefastlane.com]
  • If bleeding is severe, patients may be hypotensive or tachycardic, or may exhibit orthostatic hypotension. Physical examination should assess for guarding, rebound tenderness, prior surgical scars, and sequelae of chronic liver disease.[aafp.org]

Workup

  • Extensive workup revealed multiple diverticula in the small and large intestines without identification of any source of active bleeding in either patient. INTERVENTION: Laparoscopic exploration of the abdominal cavity was performed.[ncbi.nlm.nih.gov]
  • Etiology Although lower GI bleeding can occur at any age, specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup 2,6 : adolescents and young adults inflammatory bowel disease[radiopaedia.org]
  • Advantages of MDCT for the diagnostic workup of patients with suspected acute abdominal hemorrhage include widespread availability, speed, reproducibility and minimal invasiveness.[doi.org]
  • In general, surgery for obscure GI bleeding is indicated for patients who continue to bleed and have had negative endoscopic and radiologic workups, and who are clearly operative candidates.[acphospitalist.org]
  • In a review by Vernava and colleagues, patients with LGIB made up only 0.7% of all hospital admissions (17,941 patients); among the patients who underwent a diagnostic workup (4410 [24%]), the most common causes of bleeding were diverticular disease ([emedicine.medscape.com]
Microcytic Anemia
  • anemia, chronic blood loss Protect airway and give high-flow oxygenInsert 2 large-bore (14-16G) IV cannulate take blood for FBC, U&E, LFT, clotting, cross-match 4-6 units (1 unit per g/dL 14g/dL)Give IV colloid while waiting for blood to be crossmatched[slideshare.net]
Hemoglobin Decreased
  • Day six of hospitalization, he began having maroon stools, his hemoglobin decreased to 8.1 g/dL and his platelets to 81 1000/mcL. On day seven, the hemoglobin decreased to 6.4 mg/dL.[ncbi.nlm.nih.gov]
Entamoeba Histolytica
  • Infectious colitis The most common infectious causes of colitis worldwide are Salmonella, Shigella, Campylobacter jejuni, E coli 0157:H7, and Entamoeba histolytica.[emedicine.medscape.com]

Treatment

  • The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77).[ncbi.nlm.nih.gov]
  • The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective.[ncbi.nlm.nih.gov]
  • Herein, we present such a unique complication with computed tomography images and subsequent successful endovascular treatment.[ncbi.nlm.nih.gov]
  • In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.[ncbi.nlm.nih.gov]
  • Subsequent push enteroscopy confirmed the bleeding in proximal jejunum and allowed effective treatment with electrocautery.[ncbi.nlm.nih.gov]

Prognosis

  • Sometimes, this sort of fistula is difficult to manage and reoperation might be necessary, which would definitely worsen prognosis.[scielo.br]
  • Given all of these initial difficulties, the prognosis is sometimes just a guess. Bleeding that initially seems inconsequential may rapidly become deadly.[web.archive.org]
  • Shock: the presence of signs of shock at presentation confers a worse prognosis.[patient.info]
  • Treatment and prognosis Despite advances in therapy, the in-hospital mortality rate remains high (13%) and re-bleeding is common (15%) 5 . lower gastrointestinal bleeding (LGIB) lower gastrointestinal bleeding - differential diagnosis Promoted articles[radiopaedia.org]

Etiology

  • Abstract Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis of unknown etiology characterized mainly by the involvement of the upper airways, lungs, and kidneys.[ncbi.nlm.nih.gov]
  • Scene investigation may reveal useful clues pointing to this unusual etiology.[ncbi.nlm.nih.gov]
  • This is in contrast to reports from other parts of India, where variceal bleeding is the predominant etiology.[tropicalgastro.com]
  • Accordingly, prompt endoscopic examination for exploring the etiologies of GIB may alert physicians to predict the risk of death in AH patients with GIB. 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.[ncbi.nlm.nih.gov]
  • In general, the etiologies of the hemorrhage were similar to those generally seen in clinical practices, that is, peptic ulceration of the stomach or duodenum and esophageal varices. However, many unusual and unexpected lesions were also found.[annals.org]

Epidemiology

  • Author information 1 Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts.[ncbi.nlm.nih.gov]
  • Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206–10. 6 . Rockall TA, Logan RFA, Devlin HB, Northfield TC.[tropicalgastro.com]
  • Center for Clinical Epidemiology & Evidence‐Based Medicine, Second Military Medical University, Shanghai, China. Search for more papers by this author J.‐F.[doi.org]
  • Card , Epidemiology of Upper Gastrointestinal Bleeding , GI Epidemiology , (172-184) , (2014) .[dx.doi.org]
Sex distribution
Age distribution

Pathophysiology

  • For centuries, physicians have used gastrointestinal tubes to study gastrointestinal physiology and pathophysiology. 1 One of the unblemished icons of medicine is the placement of a nasogastric or orogastric tube to examine the gastric contents in patients[jamanetwork.com]
  • Etiology and pathophysiology Acute upper GI bleeding may originate in the esophagus, stomach, and duodenum.[doi.org]
  • World Journal of Gastrointestinal Pathophysiology. 5 (4): 467–78. doi : 10.4291/wjgp.v5.i4.467. PMC 4231512. PMID 25400991. a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad Westhoff, John (March 2004).[en.wikipedia.org]
  • There are now many trials, which have used varying doses in pathophysiological experiments, measuring, for example, hepatic venous pressure gradient and variceal pressure. The results from such trials are conflicting.[doi.org]

Prevention

  • Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population. Copyright 2015 European Federation of Internal Medicine. Published by Elsevier B.V.[ncbi.nlm.nih.gov]
  • INTRODUCTION: Dabigatran (Pradaxa) is a new oral anticoagulant approved by the Food and Drug Administration (FDA), available internationally and indicated as an alternative to warfarin for the prevention of stroke and systemic embolism in patients with[ncbi.nlm.nih.gov]
  • Patients may require transfusions, fluid replacement, endoscopic treatment, or gastric lavage and are watched carefully so as to prevent shock and hypovolemia. In all patients blood loss is evaluated and ability to coagulate is tested.[medical-dictionary.thefreedictionary.com]
  • Prevention and management of medical complications of the hospitalized elderly stroke patient. Clin Geriatr Med . 1991 ; 7 :475-482. Medline Google Scholar 8 Schmidt J, Reding M.[ahajournals.org]

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