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Lower Gastrointestinal Hemorrhage

Lower Gastrointestinal Bleeding


Presentation

  • The author presents a young patient presenting with lower gastrointestinal hemorrhage due to tuberculous appendicitis.[ncbi.nlm.nih.gov]
  • Patient We report a case of an adult in his 5th decade presenting with massive melena. Interventions On presentation the patient was tachycardic (pulse115/min), and hypotensive (BP 80/55 mmHg). His complete physical examination was unremarkable.[doi.org]
Wound Infection
  • The most common early postoperative complications are intra-abdominal or anastomotic bleeding, ileus, mechanical small bowel obstruction (SBO), intra-abdominal sepsis, localized or generalized peritonitis, wound infection and/or dehiscence, Clostridium[emedicine.medscape.com]
Maroon Stools
  • Maroon stools are maroon-colored blood mixed with stool that is often associated with a right colonic source of bleeding; however, it can also result from a more brisk, proximal source of bleeding.[accessmedicine.mhmedical.com]
  • stools (16.7%) and melena (11%).[emedicine.medscape.com]
  • One such study examined patients known to have a UGIB. 36 Fourteen percent of 727 patients with a known upper GI source had hematochezia or maroon stool on presentation.[ahcmedia.com]
Rectal Mass
  • Additional key elements include a careful and thorough inspection of the anus, palpation for rectal masses, characterization of the stool color, and a stool guaiac card test to evaluate for the presence of blood.[en.wikipedia.org]
Hypotension
  • The patient re-presented to the emergency room with recurrent bleeding, anemia, and hypotension. During a period of active bleeding, a number of diagnostic studies ultimately revealed the source to be the proximal jejunum.[ncbi.nlm.nih.gov]
  • These include, but are not limited to, hypotension, tachycardia, angina, syncope, weakness, confusion, stroke, myocardial infarction/heart attack, and shock.[en.wikipedia.org]
  • Hypotension (%) 4.7 5.7 3.8 0.39 Resting tachycardia (%) 37.3 42.5 32.3 0.04 Orthostatic hypotension (%) 16.2 21.0 8.8 0.006 Admission hemoglobin (g/dL), mean (SD) 10.2 (2.6) 9.7 (2.7) 10.7 (2.5) We also examined several clinical outcomes.[journalofhospitalmedicine.com]

Workup

  • 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]
  • Interestingly a colonoscopy done 6 months earlier for anemia workup was normal. Emergent laparotomy revealed numerous smaller intraluminal nodules scattered throughout the small bowel. Results Histopathology revealed carcinoid tumor.[doi.org]
  • (PT), platelet count, and/or bleeding time (bleeding time is only recommended in patients with bleeding disorders and in those using antiplatelet agents) Helical computed tomography (CT) scanning of the abdomen and pelvis can be used when a routine workup[emedicine.medscape.com]
Escherichia Coli 0157:H7
  • The pathophysiologic mechanism of infectious colitis may be due to either colonic tissue invasion by bacteria, such as Salmonella and Shigella, or toxin-mediated damage, as with Escherichia coli 0157:H7.[emedicine.medscape.com]
Ischemic Changes
  • No ischemic change was observed in any patients in group Ia and in two patients in group Ib. Ischemic changes were observed in six group Ib patients and both group II patients.[ncbi.nlm.nih.gov]

Treatment

  • (initial hemoglobin level, need for packed red blood cells), and treatment efficiency (necessary reoperation).[ncbi.nlm.nih.gov]

Prognosis

  • We conclude that in patients with active gastrointestinal bleeding, colonoscopy in combination with scintigraphy detect at a higher rate the cause and the site of bleeding and possibly improve the prognosis.[ncbi.nlm.nih.gov]
  • Tindall, Shauna Sherker, Julie Rae, John Wiggers 19 March 2019 View Current Issue Cochrane's plans to update its COI policy: truth and fiction David Tovey, Fergus Macbeth, Angela Webster, Ruth Foxlee 30 November 2018 Implementing systematic reviews of prognosis[cochranelibrary.com]
  • We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. Methods.[tandfonline.com]
  • Our study was not aimed at identifying the risk factors for poor outcome and has insufficient power to show significant predictive parameters for the overall prognosis of these patients.[journals.lww.com]

Etiology

  • Surgery is the definitive treatment--it confirms the etiology and rules out the presence of malignancy.[ncbi.nlm.nih.gov]

Epidemiology

  • OBJECTIVES: Population-based data on the epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage (ALGIH) are lacking.[ncbi.nlm.nih.gov]
  • Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34:643-64. Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, et al.[ijmedicine.com]
  • Lewis: Center for Clinical Epidemiology and Biostatistics, Blockley Hall, 9th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021. Dr.[dx.doi.org]
  • Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92:419-424. The incidence of lower GI bleeding increases with age.[bestpractice.bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management, 7th ed. Philadelphia; Saunders 2002 C. Ell, M. D., Ph. D.[dx.doi.org]
  • Pathophysiology Diverticulosis, angiodysplasia, colitis, carcinoma, and anorectal disease play roles in the pathophysiology of lower gastrointestinal bleeding (LGIB). [6, 10] They are briefly discussed in this section.[emedicine.medscape.com]

Prevention

  • It also appears that therapeutic colonoscopy can arrest or prevent bleeding in certain high-risk patients, offering the opportunity to change the natural history of the bleed.[ncbi.nlm.nih.gov]
  • In contrast, if the person has previously had a heart attack, the aspirin should be continued despite the active LGIB due to the benefits of preventing another heart attack and consequent death outweighing the risk of bleeding.[en.wikipedia.org]

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