Gastrointestinal Bleed Pathophysiology of GI Bleeds Crus of diaphragm Aorta Ligament of Treitz Duodeno-jejunal flexure Duodenum Jejunum Peptic Ulcer Most Common Cause Classical manifestations Hematemesis + melena Hematemesis Melena Upper GI Bleed Oesophagus Stomach Duodenum Varices Portal HTN Recent aortic surgery Pill induced? Aspirin NSAIDs Reflux induced? Cushing's Zollinger-Ellison Syndrome Massive melena Due to an ulcer Due to varices Become bulbous Massive melena Hematemesis Hypotensive shock Can be identified via endoscopy Oesophagus Stomach Duodenum Blood oxidised here in stomach Intermittent bleeds Comes from stomach Blood is not clotted Shallow mucosal erosions Think about NSAIDs or aspirin History of intense weight loss, indigestion, anaemia Malignancy Even if baseline anaemia Oesophageal varices Tears in the walls of the oesophagus Big longitudinal tears Blood backs via portal vein to gastric v. Distends oesophageal veins Become bulbous Can easily rupture Massive melena Hematemesis Hypotensive shock Can be identified via endoscopy Similar causes as gastric ulcers Lower GI Bleeds (usually associated with pts who have aortic stenosis) Large intestine IRM IV Esp. in UC Hemorrhoids Internal External Bleeding right into the lumen Hematochezia Classic finding Mainly in ascending colon Weird connections between the a.v. of ascending colon Diverticulosis (most common cause of LGI bleed) Sheaths/diverticula Stretches shears the a.v. with inside the diverticula Hemorrhoids Not as painful above pectinate line Very painful below pectinate line Both can bleed almost when wiping anus & when defecating Issues with GI Bleeds Hematochezia Clammy The rule of 2 ↓ plasma ↓ RBC ↓ Hb ↓ hematocrit ↓ EV ↓ JCV ↓ CO ↓ MAP Influence vasconstrictive response form men Hypovolemic/hemorrhagic shock