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Gastrointestinal Bleeding

Gastrointestinal Bleeding is a topic covered in the 5-Minute Emergency Consult.

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  • 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 of age >70
    • Upper GI bleed (UGIB) 6–8%; variceal 30–50%
    • Lower GI bleed (LGIB) 2–4%


Upper GI Bleed (UGIB):
  • 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
  • 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:
    • Angiodysplasia (8%)
    • Radiation telangiectasia
    • Aortocolonic fistula
  • Inflammatory bowel disease:
    • Crohn's 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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Rosen, Peter, et al., editors. "Gastrointestinal Bleeding." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307149/all/Gastrointestinal_Bleeding.
Gastrointestinal Bleeding. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307149/all/Gastrointestinal_Bleeding. Accessed April 24, 2019.
Gastrointestinal Bleeding. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307149/all/Gastrointestinal_Bleeding
Gastrointestinal Bleeding [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307149/all/Gastrointestinal_Bleeding.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastrointestinal Bleeding ID - 307149 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307149/all/Gastrointestinal_Bleeding PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -