Escolar Documentos
Profissional Documentos
Cultura Documentos
- Diagnosis
- Assesment
- Treatment
Topography:
Upper GI bleeding
proximal to the ligament of
Treitz
hematemesis melena
hematochezia
Upper GI bleeding
History of liver disease or
1. Initial evaluation : alcohol abuse Varices
History Renal disease, aortic stenosis
Angiodysplasia
Symptom assessment
History of Helicobacter pylori,
Physical examination nonsteroidal anti-inflammatory
drug (NSAIDs) use- Peptic
Lab tests (CBC, BUN, ulcer disease
PT, INR)
Nasogastric lavage
Normocytic
Controversial red blood Epigastric or right upper quadrant
cells - Assessment of pain - Peptic ulcer
Confirms an hemodynamic stability
acute
upper GI source Odynophagia, gastroesophageal
bleeding
Facilitates Microcytic Examination of the
reflux, dysphagia - Esophageal ulcer
Blood volume
SHOCK
> 40%
Hematocrit determination
severity of an episode of GI bleeding can not be
estimated immediately after bleeding by Ht or Hb values
because the blood loss consists of figurative elements
and plasma.
Ht / Hb decrease begins with the restoration of plasma V;
24-72 hours are required to complete the process -> Hb
underestimates the severity of the haemorrhage in the
early days.
patient follow-up: clinical (!), TA, AV, stool, Hb.
Laboratory tests
Duodenal ulcer
cauterization with Gold Probe Duodenal ulcer, Forrest II A
Mecanical hemostasis using
metalic clips
Argon plasma
coagulation (APC)
Consequence of portal
hypertension.
Diverticulosis 35 %
Colitis (infectious, 16 %
ischemic)
IBD 13 %
Neoplasia 10 %
Anorectal (hemorrhoids, 16 %
anal fissures, rectal ulcer)
Angiodysplasia 3%
Radiation colitis 3%
Miscellaneous 4%
Diverticulosis
A diverticulum is a sac-like protrusion of the colonic wall.
Friability/spontaneous
bleeding
Crohns disease aphtous
ulcers
Crohns disease
cobblestone sign
Angiodysplasia
Cecum 37 percent
Ascending colon 17
percent
Transverse colon 7 percent
escending colon 7 percent
Sigmoid colon 18 percent
Rectum 14 percent Angiodysplasia of the
cecum
Transverse colon
Ischemic colitis in the elderly, most commonly
affecting sigmoid, descending colon, splenic flexure;
- Colicky abdominal pain, followed at ~ 24 h by
emission of red blood or bloody diarrhea (minimally);
Radiological exam: "thumb printing"
Dg: colonoscopy with biopsy.
Infectious colitis: C. jejuni, Salmonella, Shigella, CD or
viral = CMV ; fecal culture + antibiotics
Colitis radical: immediately or years after Rx-therapy.
Chronic mild bleeding with iron deficiency anemia.
Dg: patient history + colonoscopy with biopsy.
Treatment: electrocoagulation, APC.
ISCHEMIC COLITIS endoscopic view +
Rx (thumbprinting)
Perianal lesions
- Hemorrhoids;
- anal fissures.
!! rectal polyps and cancer - patients with a history of LGIB require careful
endoscopic examination of the anal canal, rectum and sigmoid.