TAILIEUCHUNG - Chapter 042. Gastrointestinal Bleeding (Part 1)

Harrison's Internal Medicine Chapter 42. Gastrointestinal Bleeding Gastrointestinal Bleeding: Introduction Bleeding from the gastrointestinal (GI) tract may present in five ways. Hematemesis is vomitus of red blood or "coffee-grounds" material. Melena is black, tarry, foul-smelling stool. Hematochezia is the passage of bright red or maroon blood from the rectum. Occult GI bleeding (GIB) may be identified in the absence of overt bleeding by a fecal occult blood test or the presence of iron deficiency. Finally, patients may present only with symptoms of blood loss or anemia such as lightheadedness, syncope, angina, or dyspnea. Sources of Gastrointestinal Bleeding . | Chapter 042. Gastrointestinal Bleeding Part 1 Harrison s Internal Medicine Chapter 42. Gastrointestinal Bleeding Gastrointestinal Bleeding Introduction Bleeding from the gastrointestinal GI tract may present in five ways. Hematemesis is vomitus of red blood or coffee-grounds material. Melena is black tarry foul-smelling stool. Hematochezia is the passage of bright red or maroon blood from the rectum. Occult GI bleeding GIB may be identified in the absence of overt bleeding by a fecal occult blood test or the presence of iron deficiency. Finally patients may present only with symptoms of blood loss or anemia such as lightheadedness syncope angina or dyspnea. Sources of Gastrointestinal Bleeding UPPER GASTROINTESTINAL SOURCES OF BLEEDING Table 42-1 The annual incidence of hospital admissions for upper GIB UGIB in the United States and Europe is with a mortality rate of 5-10 . Patients rarely die from exsanguination rather they die due to decompensation from other underlying illnesses. The mortality rate for patients 60 years in the absence of major concurrent illness is 1 . Independent predictors of rebleeding and death in patients hospitalized with UGIB include increasing age comorbidities and hemodynamic compromise tachycardia or hypotension . Table 42-1 Sources of Bleeding in Patients Hospitalized for Upper GI Bleeding in Years 2000-2002 Sources of Bleeding Proportion of Patients Ulcers 31-59 Varices 7-20 Mallory-Weiss tears 4-8 Gastroduodenal erosions 2-7 Erosive esophagitis 1-13 Neoplasm .

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