BLEEDING FROM THE GUT

BLEEDING FROM THE GUT

• Anatomical landmark to differentiate between "upper GI" and "lower GI" bleeding - ligament of TREITZ

CAUSES OF UPPER GI BLEEDING/HEMATEMESIS

1. PEPTIC ULCER DISEASE: (Leading cause for hematemesis)

• Duodenal ulcer - gastroduodenal artery - managed by endoscopy + cautery
• Gastric ulcer - left gastric artery - managed by endoscopy + cautery

2. DRUG INDUCED GASTIRITIS: COX - inhibitors

3. PORTAL HYPERTENSION:(splenomegaly will be noted)

4. MALLORY WEISS SYNDROME:(sub mucosal tear)

• keypoints: RETCHING episodes Alcoholic binge drinking/hyperemesis gravidarum
• primary site of tear : lower esophageal sphincter and starts from cardia
• source of bleeding : left gastric artery

5.DIEULAFOY'S LESION:Aberrant sub mucosal artery bleed

6.GAVE-GASTRIC ANTRAL VASCULAR ECTASIA: Water melon stomach

LOWER GI BLEEDING:

HEMATOCHEZIA: fresh blood in stool

1. PILES/INTERNAL HEMORRHOIDS:"Flash in the pan" painless bleed.post defecation and present with anemia

IOC - PROCTOSCOPY

2. DIVERTICULITIS: Inflammation of the wall of diverticulosis 

site : sigmoid colon

diagnosis : use BA enema or colonoscopy

saw tooth pattern

IOC - CT abdomen

Treatment

1. localized abscess : liquid diet + antibiotics oral (10 days)

2. walled up abscess : IV antibiotics

3. purulent peritonitis : surgical exploratory laprotomy

4. gross fecal contamination

3.INFLAMMATORY BOWEL DISEASE:

Ulcerative colitis and crohns disease

4.MALIGNANCY COLON:

CA. CAECUM - bleeding

CA. RECTUM - Napkin ring stricture

investigation: rectal biopsy followed by DUKE staging

5.ANGIODYSPLASIA OF COLON:

Vascular malformation of colon

IOC - Angiography

MELENA

Presentation: 60ml blood ,6 -8hours in the gut to results in black tarry stool

cause:

peptic ulcer disease , erosive gastritis , portal HTN , mallory weiss

IOC; upper GI endoscopy

HEMOBILIA:(Upper GI bleeding)

causes:

trauma (lap cholecystectomy) , instrumentation , cholangiocarcinoma , klatskin tumor , parasites

IOC : Angiography

TREATMENT: GEL EMBOLIZATION OF BLEEDER

CAUSES OF HEMATOCHEZIA IN PEDIATRIC:

RECTAL POLYPS , MECKEL'S DIVERTICULUM

RULE OF 2: 2% population , 2 inch size , 2 feet from ileocaecal junction , 2 mucosa stomach/pancreatic

remnant of vitello intestinal duct and occurs on anti-mesenteric border

asymptomatic > 90%

IOC - TC99 pertechnate scan

TREATMENT: Resection and end to end anastomosis

ESOPHAGEAL DISORDERS

1. Zenker diverticulum

2. Diffuse esophageal spasm

3. Achalasia cardia

4. Nut cracker esophagus

5. GERD(Gastroesophageal reflux disease)

6. Barrett esophagus