UPPER GIB

Definition Clinical Presentation Intraluminal blood loss above the Ligament of Treitz Commonly presents with hematemesis (vomiting of blood or coffee-ground like material) And/or melena (black, tarry stools, usually from digested blood) Other symptoms UGIB > LGIB include nausea, vomiting, epigastric pain, vasovagal reactions, syncope. Peptic ulcer disease 55% Esophageal varices 14% Vascular malformations 6% Mallory-Weiss tear 5% Tumor 4% Erosions 4% Dieulafoys lesion 1 % Other 11%

LOWER GIB
Intraluminal blood loss below the Ligament of Treitz Common symptoms include hematochezia (passage of maroon or bright red blood or blood clots per rectum) Other common symptoms include diarrhea and tenesmus Note: Melena can be seen with a slow right-sided colonic bleed Note: Hematochezia can be seen w/ massive UGIB. Diverticulosis 30% After polypectomy 7% Ischemia 6% Ulcerations 6% Malignancy 5% Angiodysplasia 4% Radiation proctopathy 2% Inflammatory bowel disease 2% Miscellaneous 12% Undiagnosed 26%

Most Common Causes

History/ Physical Exam Clues to Determine Etiology

H/o PUD or dyspepsia, epigastric tenderness NSAID use Gastritis, PUD Alcohol use Gastritis, varices H/o or stigmata of cirrhosis, distended abdominal veins Retching w/ post hematemesis MalloryWeiss tears Trauma, burns, sepsis stress erosions h/o CA, LAD, or abd mass h/o nosebleeds,telangiectasias Osler-Weber-Rendu syndrome Coagulopathy, anticoag meds

Abd pain/cramping with abdominal tenderness IBD, infectious colitis, intussusception, ischemic colitis Age <40 Meckels, AIDS, IBD, int hemorrhoids Wt loss, palpable mass, rectal mass Malignancy, rectal cancer BRB on toilet paper or around stool anal fissure, hemorrhoids, rectal polyp, CA Systolic murmur radiating to carotids Aortic stenosis assoc with angiodysplasia Recent bowel surgery, h/o AAA surg