Académique Documents
Professionnel Documents
Culture Documents
del Rosario
2308190682
Sec A
July 6, 2015
A. Definition of concepts:
1. Massive GI bleedingCan be divided into Upper GI bleeding or Lower GI bleeding that requires
transfusion of at least 4 units of blood during 24 hours in the hospital or as hypotension with systolic BP
<90mmHg
2. Occult GI bleedingGI bleeding not visible to the physician or patient. It results to a positive occult
blood test or iron deficiency anemia.
3. Obscure Bleedingpersistent or recurrent bleeding from GI tract after negative evaluations with upper
and lower endoscopes
4. Upper GI bleedingBleeding in the esophagus, stomach and first part of the small intestines
5. Lower GI bleedingBleeding in majority of the small intestines. Large intestines or bowels, rectum and
anus
6. Hematemesisvomiting out blood either fresh or coffee ground in nature
7. Melenablack, tarry stools usually from bleeding in the upper GI where acids have reacted to the
blood
8. HematocheziaPassage of fresh blood in the anus with or in stools
9. Anatomic Landmark of Upper GI and Lower GI tract in relation to bleedingLigament of Treitz
10. Hematobiliaupper GI tract bleeding that originates from the biliary tract (Biliary tract hemorrhage)
11. Angiodyplasia vs. Diverticula
Angiodysplasia
Definition: Small vascular malformation of the got
Cause: unexplained GI bleeding and anemia
Lesions: multiple frequently involve the cecum or
ascending colon
Treatment: colonoscopic interventions, angiography
and embolization, medication or surgery
Diverticula
Definition: outpouching of a hollow structure in the
body either true or fals
Cause: high pressure within the colon pushes
against weak spots
Location: end of the descending and sigmoid colons
and first section of the small intestine
Treatment: bipolar probe coagulation, epinephrine
injection and metallic clips
Traumatic
Cardiogenic
- Intrinsic
- Compressive
Septic
- Hyperdynamic (early)
- Hypodynamic (late)
Neurogenic
Hypoadrenal
Manifestation
Anxiety, cold, clammy skin, confusion, decreased or
no urine output, general weakness, pallor,
tachycardia, sweating, unconsciousness
Insomnia, nightmares, startled easily, tachycardia,
fatigue, aches and pains, difficulty concentrating,
edginess and agitation, muscle tension
Tachypnea, shortness of breath, tachycardia, loss of
consciousness, weak pulse, sweating, pallor, cold
hands and feet, decreased urine output
Patches of discolored skin, decreased urine output,
confusion, tachypnea, diffulty of breathing,
palpitations, tachycardia, chills, extreme weakness
and lightheadedness
Warm extremities, decreased urine output, flaccid
paralysis below the injury, loss of spinal reflexes,
sensation, sweating and sphincter tone
Abdominal pain, confusion, dehydration, dizziness,
fatigue, flank pain, headache, high fever, loss of
appetite, loss of consciousness, nausea, low BO,
weakness, tachycardia, tachypnea, excessive
sweating, vomiting
Angiodysplasia
Ischemic Colitis
Rule in
Hematochezia
Abdominal Pain
Full abdomen
Pallor
(+) fresh blood on DRE
Above 50 years old
(+) fresh/maroon blood on DRE
Hematochezia
BP 90/60, HR 120/min, RR 23/min
Pallor
Full Abdomen
Hypoactive bowel sounds
(+)tenderness on RLQ and LLQ
(+) fresh/maroon blood on DRE
Hematochezia
BP 90/60, HR 120/min, RR 23/min
Pallor
Full Abdomen
Hypoactive bowel sounds
(+)tenderness on RLQ and LLQ
65 years old
Rule Out
Short duration of symptoms
Rule out through endoscopy and
biopsy
Painless, self-limited
hematochezia
Slow, repeated episodes of
bleeding
Case 2
A. The initial assessment based on the above clinical data is: Upper Gastrointestinal Bleeding
secondary to Gastric Varices
B. Give 3 differential diagnosis/basis
Disease
Bleeding Peptic ulcer
Hemoilia
Gastrointestinal Cancer
Rule In
Abdominal pain
Full abdomen
Hematemesis
Melena
HR 130/min
RR 25/min
Pallor, weak and thread pulse
Hyperactive bowel sounds
Melena on DRE
Syncope and body weakness
Abdominal pain
Full abdomen
Hematemesis
Melena
HR 130/min
RR 25/min
Pallor, weak and thread pulse
Hyperactive bowel sounds
Melena on DRE
Syncope and body weakness
Abdominal pain
Full abdomen
Hematemesis
Melena
HR 130/min
RR 25/min
Pallor, weak and thread pulse
Hyperactive bowel sounds
Melena on DRE
Syncope and body weakness
Rule out
No history of NSAIDs use
Hypertensive
No history of PUD
Rule out through endoscopy
No jaundice
No history of instrumentation,
gallstone, inflammatory conditions
etc.
Rule out through endoscopy