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Acute
Gastrointestinal
Bleeding
Smoking
Diverticulitis or angioectasias
High-fiber diets may help
Variceal bleeding
Nonselective beta-blockers and endoscopic therapy
Lower GI bleeding
Reduce exposure to NSAIDS, antiplatelet agents,
anticoagulants
Few measures help in prevention
Bloody diarrhea
Presyncope or syncope
Upper GI bleeding
Nausea, dyspepsia
Lower GI bleeding
Altered bowel habits, lower abdominal pain, rectal
discomfort
Dieulafoy lesion
Radiation proctopathy
Physical exam
Routine exam + assess vital signs on postural changes
Examine stool
EGD
For melena and hematemesis
For subset with hematochezia from upper GI source
Angiography
Allows intervention if lesion localized
Requires active bleeding at time of study
Nuclear imaging
Angiography
Surgical resection: if bleeding doesn’t resolve (≈20%)
Segmental colectomy: if bleeding can be localized
Subtotal colectomy: if bleeding can’t be localized source
Hemoglobin levels
Check at least every several hours initially