Hematemesis and Rectal Bleeding: Diagnosis and Tests

Guide 1 A. Hematemesis 1. Diagnosis and Comments -Pseudoxanthoma elasticum: Hemorrhage sever, Results from degeneration of elastic tissue infeatures noted pn skin -Hereditary hemorrhagic telangiectasia: Autosomal dominant, Hemorrahage Thinning of musculairs layr and absence of elastin in arterial wall -Von Willebrand disease: Deficiency of von Willebrand factor -Budd-Chiari syndrome: Associated with esophageal varices -Duodenal diverticula: rare cause of hemorrhage -Polycystic kidneys: Associated with congenital hepatic fibrosis and esophageal varices -Acute febrille disorders: variola, infective endocarditis, yellow fever rare cause of hemorrhage -Head injury: Gastric erosions -Burns: Curling ulcer -Mediastinal tumor perforating: Sever hematemesis -Esophagus & aorta -Carcinoma of the stomach: Carcinoma is rare and so too the other tumors of the stomach -Hemangioma of the stomach -Leiomyoma of the stomach -Duodenal tumors: Rarer than tumors of the stomach -Carcinoma of head of pancreas: Invading duodenum, resulting in Helatemesis -Poral hypertension: secondary to chronic liver disease/portal Vein obstruction -Esophageal varices: following a coholic cirrhosis -Malignant hypertension -Previous aortic graft for abdominal: Aortoduodenal fistula-“herald bleed” -Aneurysm -Bleeding diathesis: Polycythemia rubra Vera Thrombocytopenia purpura Leukemia leukemic infltrate may be present in stomach and erode Aplastic anemia Hemophilia -Acute gastritis: Alcohol, corrosive poisons -Uremia: Chronic nephritis-patient has high blood Pressure -Scurvy: Vitamin C deficiency due to inadequate intake or due to malabsorption as in Crohn/celiac disease -Autoimmune disorders: Systemic lupus erythematosus Polyarteritis nodosa -Erosive gastritis: Medications such as aspirin, NSAIDs.NSAIDs are the most common cause of erosive gastritis Anticoagulants, corticosteroids -Esophageal ucler: Tetracycline capsules, potassium tablets -Postsurgical: Stomach/duodenal surgery -Munchausen syndrome: Patients deliberately drink/swallow blood and then vomit it so as to deceive physician -Esophagitis -Gastroesophageal reflux -Mallory-Weiss syndrome: Severe retching followed by vomiting in alcoholics causes tearing of lower esphagus -Hiatus hernia -Gastric ulcer -Duodenal ulcer -Gallstones ulcerating into duodenum 2-Test and Reason -CBC: Hb/HCT -WBC count: Leukemia -Type and cross match: For blood transfusion if required -Bone marrow biopsy: Aplastic anemia -Peripheral blood smear: Thrombocytopenia -Platelet count: Thrombocytopenia -Prothrombin time: Vitamin K deficiency, cirrhosis of the liver -Ristocetm test: Von Willebrand disease -BUN: Uremia/ cirrhosis of liver/chronic nephritis -ANA (antinuclear antibody): Systemic lupus erythematosus. -Anti-dsDNA: Systemic lupus erythematosus -Chest x-ray: Mediastinal mass -Endoscopy: Evaluating esophagus/ stomach duodenum -Ultrasound of the abdomen: Cholelithiasis B. Rectal bleeding Key points . Rectal bleeding may be bright red black tarry stool (malena) . 50-80 ml of blood loss is sufficient to cause malena. 1-Diagnosis and Comments Meckel diverticulum: Peptic ulceration in the diverticulum -Diverticular disease: Hemorrhage is excessive -Intussusception:“Red currant jelly” bloody diarrhea -Ehlers-Danlos syndrome -Rectal tear/sexual instrumentation: Bright red -Liver trauma: Due to hematobilia -Colitis: Secondary to shigella, Campylobacter, Histolytica salmonella -Typhoid fever: Bleeding from ulcreated peyer patches in small bowel -Colonic carcinoma -Colonic polyps -Hepatic tumors: Due hematobilia -Leiomyoma -Leiomyosarcorna -Mesenteric thrombosis -Mesenteric embolism -Angiodysplasia of colon: usually in elderly, bleeding massive.Associated with Aortic stenosis or renal disease -Hemorrhoids: Bright red blood, no pain on defecation -Anal fissuye: Bright red blood plus pain on defecation -Blood dyscrasias -Hemobilia: Bleeding into the biliary tract due to Gallstooes Blood enters the GI tract -Anticoagulant therapy -Prolonged NSAID use: especially in elderly -Oral iron: including preparations containing iron Iron is converted to iron sulfide Bismuth preparations -Spurious: From swallowed blood bleeding Gums/hemoptysis -Peptic esophagitis 2-Test and Reason -Rectal exam -Complete Blood Count: HCT -Occult blood: Presence of blood in absence of gross evidence -Type and crossmatch: for blood transfusion if required -Endoscopy: Evaluating Esophagus/stemach/duodmmn -Proctosigrnoidoscopy: Crohn disease