TAILIEUCHUNG - 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 BleedingUpper Gastrointestinal Sources of Bleeding . | 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 quot coffee-grounds quot 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 BleedingUpper 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 Source Data from M Van Leerdam et al Am J Gastroenterol 98 1494 2003 DM Jensen et al Gastrointest Endosc 57 AB147 2003 KC Thomopoulos et al Eur J Gastroenterol Hepatol 16 177 2004 F Di Fiore et al Eur J Gastroenterol Hepatol 17 641 ulcers are the most common cause of UGIB accounting for up to 50 of cases an increasing proportion is due to nonsteroidal antiinflammatory drugs NSAIDs with the prevalence of Helicobacter pylori decreasing. Mallory-Weiss tears account for 5-10 or 15 of cases. The proportion of patients bleeding from varices varies widely from 5 to 30 depending on the population. Hemorrhagic or erosive gastropathy . due to NSAIDs or alcohol and erosive esophagitis .

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