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GASTROINTESTINAL BLEEDING

GASTROINTESTINAL BLEEDING. Hematemesis Melena Hematochezia Occult bleeding. CLINICAL PRESENTATION. Clinical manifestations of GI bleeding depends upon extent & rate Postural hypotension suggests acute hemorrhage & intravascular volume depletion

dominic-kelley
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GASTROINTESTINAL BLEEDING

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  1. GASTROINTESTINAL BLEEDING • Hematemesis • Melena • Hematochezia • Occult bleeding

  2. CLINICAL PRESENTATION • Clinical manifestations of GI bleeding depends upon extent & rate • Postural hypotension suggests acute hemorrhage & intravascular volume depletion • Fatigue & exertional dyspnea typical symptoms with slow, chronic blood loss

  3. ETIOLOGY OF UGI BLEEDING • Differential diagnosis is extensive • Major causes; • PUD • Esophageal/Gastric Varices • Esophagitis • Mallory-Weiss tear

  4. ETIOLOGY OF LOWER BLEED • Anal and rectal lesions • Colonic lesions • Diverticula

  5. HISTORY • Consider factors that may cause false + FOBT • Postural hypotension helps determine need for hospitalization • H/O PUD, recent use of NSAIDs • Weight loss & change in bowel habits • H/O liver disease, ETOH abuse, inflammatory bowel disease

  6. PHYSICAL • Orthostatic changes in pulse & BP • Cardiopulmonary • Skin • Examine oral cavity & nasopharynx • Lymph nodes • Abdomen • Digital rectal

  7. DIAGNOSTIC TESTS • CBC • PT, PTT • Other lab tests relevant to physical findings • Upper endoscopy if stable • Colonoscopy

  8. INDICATIONS FOR ADMISSION & REFERRAL • Admit pts with h/o recent brisk bleeding & orthostatic changes • Admit pts with less sever blood loss who have comorbid conditions aggravated by anemia • Profound anemia with no evidence of blood loss • Refer pts who are candidate for endoscopy or colonscopy when source of bleeding is elusive

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