Chapter 042. Gastrointestinal Bleeding (Part 1)

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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 ...

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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 ~0.1%, 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
Ulcers 31–59 Varices 7–20 Mallory-Weiss tears 4–8 Gastroduodenal erosions 2–7 Erosive esophagitis 1–13 Neoplasm 2–7
Vascular ectasias 0–6 No source identified 8–14 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, 2005. Peptic ulcers are the most common cause of UGIB, accounting for up to ~50% of cases; an increasing proportion is due to nonsteroidal anti-inflammatory 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 (e.g., due
to NSAIDs or alcohol) and erosive esophagitis often cause mild UGIB, but major bleeding is rare.