Gastro Intestinal Bleeding

Gastro Intestinal Bleeding
Presentation by:David A. Gremse, MD, FAAP, FACG
Professor and Chair of Pediatrics
University of Nevada School of Medicine

Gastrointestinal Bleeding

* Hematemesis- Vomiting of bright red blood
o usually represents bleeding proximal to the ligament of Treitz
* Hematochezia- bright red blood per rectum
o indicates a lower GI source of bleeding
* Blood has a laxative effect so with massive bleeding the stool may be bright red
* Blood streaks on the stool indicates anal outlet bleeding
* Blood mixed with stool indicates bleeding source higher than the rectum
* Blood with mucus indicates an infectious or inflammatory disease
* Currant jelly-like material indicates vascular congestion and hyperemia (intussusception or midgut volvulus)
* Maroon-colored stools indicate voluminous bleeding proximal to the rectosigmoid area
* Melena, passage of black, sticky (tarry) stools suggests upper GI tract bleeding, but can be as distal as the right colon
* Hematemesis suggests a large bleed with possible recurrence, melena alone indicates less voluminous bleeding

Causes of Upper GI Bleeding

* Common
* Nasopharyngeal bleeding
* Erosive Esophagitis
* Peptic ulcer
* Gastritis (H. pylori)
* Mallory-Weiss tear
* Prolapse gastropathy

* Less Common
* Bleeding disorders
* Duplication cyst
* Foreign body
* Tube trauma
* Vascular malformation
* Esophageal varices


Causes of Lower GI Bleeding

* Common
* Anal fissure
* Infectious colitis Salmonella, Shigella, Campylobacter, C.diff
* Inflammatory bowel disease
* Intussusception
* Upper GI source

* Less Common
* Meckel’s diverticulum
* Duplication cyst
* Hirschsprung’s enterocolitis
* Gangrenous intestine
* Vascular malformation

Clinical Findings in PUD Neonatal Period
Clinical Findings in PUD Infants and Toddlers
Clinical Findings in PUD Pre-Schoolers
Clinical Findings in PUD School Age
Pathophysiology of GI Bleeding
Causes and Effects of H+ Ion Backdiffusion
Lowflow states Drugs, EtOH Stress H. pylori Bile Reflux
Mucosal Barrier Break
Parietal Cells
Release of histamine + Vasodilatation
Increased HCl and Pepsin Secretion
Peptic Ulcer Disease Diagnostic Evaluation
Indications for EGD
Case #1 – UGI Bleeding
Esophageal varices
Case #2 – UGI Bleeding
Prolapse Gastropathy
Meckel’s Scan
99mTc- Labeled Red Cell Scan
GI Bleeding - Treatment
Drug Efficacy in Healing Ulcers
ATLS Classification of Shock
Management - Octreotide
GI Bleeding – Summary
Questions

Gastro Intestinal Bleeding.ppt