Gastrointestinal Bleeding
Gastrointestinal Bleeding is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Bleeding from GI tract:
- Upper GI tract: Proximal to ligament of Treitz
- Lower GI tract: Distal to ligament of Treitz to anus
- Mortality rate:
- 10% overall; from <5% in children up to 25% for adults age >70
- Upper GI bleed (UGIB) 6–8%
- Variceal 30–50%
- Lower GI bleed (LGIB) 2–4%
Etiology
Upper GI Bleed (UGIB):Etiology
- Ulcerative disease of upper GI tract:
- Peptic ulcer disease (40%):
- Helicobacter pylori infection
- Drug-induced (NSAIDs, aspirin, glucocorticoids, K+ supplements, Fe supplements)
- Gastric or esophageal erosions (25%):
- Reflux esophagitis
- Infectious esophagitis (Candida, HSV, CMV)
- Pill-induced esophagitis
- Esophageal foreign body
- Gastritis and stress ulcerations:
- Toxic agents (NSAIDs, alcohol, bile)
- Mucosal hypoxia (trauma, burns, sepsis)
- Cushing ulcers from severe CNS damage
- Chemotherapy
- Peptic ulcer disease (40%):
- Portal HTN:
- Esophageal or gastric varices (10%)
- Portal hypertensive gastropathy
- Arteriovenous malformations:
- Aortoenteric fistula (s/p aortoiliac surgery)
- Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome)
- Dieulafoy vascular malformations
- Gastric antral vascular ectasia (GAVE or watermelon stomach)
- Idiopathic angiomas
- Mallory–Weiss tear (5%)
- Gastric and esophageal tumors
- Pancreatic hemorrhage
- Hemobilia
- Strongyloides stercoralis infection
Lower GI Bleed (LGIB):
- Diverticulosis (33%)
- Cancer or polyps (19%)
- Colitis (18%):
- Ischemic, inflammatory, infectious, or radiation
- Vascular (8%):
- Angiodysplasia
- Radiation telangiectasia
- Aortocolonic fistula
- Inflammatory bowel disease:
- Crohn disease and ulcerative colitis
- Postpolypectomy
- Anorectal (4%):
- Hemorrhoids (internal and external)
- Anal fissures
- Anorectal varices
- Rectal ulcer
- Foreign body
Pediatric Considerations
Meckel diverticulum and intussusception are the most common causes of LGIB in children
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Basics
Description
Description
- Bleeding from GI tract:
- Upper GI tract: Proximal to ligament of Treitz
- Lower GI tract: Distal to ligament of Treitz to anus
- Mortality rate:
- 10% overall; from <5% in children up to 25% for adults age >70
- Upper GI bleed (UGIB) 6–8%
- Variceal 30–50%
- Lower GI bleed (LGIB) 2–4%
Etiology
Upper GI Bleed (UGIB):Etiology
- Ulcerative disease of upper GI tract:
- Peptic ulcer disease (40%):
- Helicobacter pylori infection
- Drug-induced (NSAIDs, aspirin, glucocorticoids, K+ supplements, Fe supplements)
- Gastric or esophageal erosions (25%):
- Reflux esophagitis
- Infectious esophagitis (Candida, HSV, CMV)
- Pill-induced esophagitis
- Esophageal foreign body
- Gastritis and stress ulcerations:
- Toxic agents (NSAIDs, alcohol, bile)
- Mucosal hypoxia (trauma, burns, sepsis)
- Cushing ulcers from severe CNS damage
- Chemotherapy
- Peptic ulcer disease (40%):
- Portal HTN:
- Esophageal or gastric varices (10%)
- Portal hypertensive gastropathy
- Arteriovenous malformations:
- Aortoenteric fistula (s/p aortoiliac surgery)
- Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome)
- Dieulafoy vascular malformations
- Gastric antral vascular ectasia (GAVE or watermelon stomach)
- Idiopathic angiomas
- Mallory–Weiss tear (5%)
- Gastric and esophageal tumors
- Pancreatic hemorrhage
- Hemobilia
- Strongyloides stercoralis infection
Lower GI Bleed (LGIB):
- Diverticulosis (33%)
- Cancer or polyps (19%)
- Colitis (18%):
- Ischemic, inflammatory, infectious, or radiation
- Vascular (8%):
- Angiodysplasia
- Radiation telangiectasia
- Aortocolonic fistula
- Inflammatory bowel disease:
- Crohn disease and ulcerative colitis
- Postpolypectomy
- Anorectal (4%):
- Hemorrhoids (internal and external)
- Anal fissures
- Anorectal varices
- Rectal ulcer
- Foreign body
Pediatric Considerations
Meckel diverticulum and intussusception are the most common causes of LGIB in children
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