0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47
Gastrointestinal Bleeding 615■chronic bleeding from ulcer or neoplasm: hypochromic, microcytic
anemia with low serum iron and ferritin and elevated transferrin
levels
Upper GI Endoscopy
■routine first step for symptoms/signs of upper GI bleeding; if first
exam is unclear then repeat evaluations helpful; occasionally, super-
ficial atypical lesions are missed (i.e., vascular ectasias, gastric
varices)
Colonoscopy
■test of choice for lower GI bleeding; cannot perform exam in patient
actively bleeding – requires adequate bowel preparation – prep can
be done in 4–6 hours
Other Tests:
■Red blood cell technetium scan – sensitive for bleeding at rates of
1 unit RBC every 2–4 hours
■Enteroscopy – uses 3-meter-long endoscope – reaches 1 meter
beyond ligament of Treitz
■Angiography – requires brisk bleeding at rates of 1–2 units/hr
■Exploratory laparotomy – not useful unless combined with intraop-
erative panenteroscopy (scope passed directly into small bowel and
guided proximally and distally)
■Capsule video enteroscopy: relatively new technique, extremely use-
ful when endoscopy and colonoscopy are reliably negativedifferential diagnosis
■Major sources of bleeding – upper GI tract
➣Esophagitis
➣Mallory-Weiss tears
➣Varices
➣Gastric ulcer
➣Gastritis
➣Gastric varices
➣Pyloric channel ulcer
➣Duodenal ulcer
➣Duodenitis
Gastric or esophageal cancer
Dieulafoy’s lesions (single superficial blood vessel)
■Major sources of bleeding – lower GI tract
➣Hemorrhoids
➣Ulcerative proctitis/colitis