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GASTROINTESTINAL BLEEDING
EPIDEMIOLOGY
• The incidence of bleeding from the upper GIT tract is approximately
100 cases per 100,000 population.
• The most common cause of upper GI hemorrhage is peptic ulceration
of the stomach or duodenum, with or without aspirin or NSAID. 50%
duodenal ulcers are silent.
• The next most common cause is variceal bleeding, then Mallory-Weiss
syndrome with laceration from excessive vomiting with trauma, and
then simple erosive disease of the stomach or duodenum.
CLINICAL PICTURE
• Hematochezia (blood in feces)
• Anemia/ paleness
• Hypovolemia, until shock
• Melena
DIAGNOSIS
• Upper endoscopy: best procedure for diagnosing GI bleeding.
• Angiography
• Enteroscopy
MANAGEMENT
• 85% massive upper GI bleeding is controlled by transfusion and PPI or
significant antacid.
• Epinephrine injection, cauterization, and heater-probe cautery by
endoscopic have been successful in controlling most lesions, if
endoscopist is able to identify a bleeding vessel.
• 10-15% require surgical intervention. The criterion: need 4-6 units of
blood transfusion.
• 5-10% in unidentified etiology of GI bleeding, therapy becomes
supportive, with intermittent blood replacement & continuing
diagnostic efforts.
COURSE AND PROGNOSIS
• Treatment:
- Stage 1 antibiotic eradication of H. pylori,
in 1-2 mo eradication should be established,
endoscopy evaluation after.
- Endoscopic evaluation every 6 mo in 2 years.
- Complete remission in 70% patient. Occur
rapidly to 18 months.
- Stage II or III: antibiotic eradication +
chemotherapy
- Stage IV: chemotherapy, local radiation with
or without surgery.
DIFFUSE LARGE B-CELL LYMPHOMA
• 45-50% gastric lymphoma. Etiology is not clear.
• Lesion occur in the body & in the antrum of the stomach, tend to be
multifocal. Typically invade the tunica muscularis, histology reveals
clusters or sheets of large cells.
• Clinical picture: ulcerative lesions, bleeding, abdominal pain, nausea
and anorexia. Elevated LDH.
• Diagnosis: upper endoscopy and CT evaluation of the chest, abdomen,
and pelvis.
• Treatment: 70% in stage I have no recurrence in 5 years with surgical
therapy. Responsive to radiation & chemotherapy.
CANCERS OF THE STOMACH
CANCERS OF THE STOMACH
• 2 types of stomach cancers: intestinal form (glandlike tubular
structures) and diffuse form (poorly differentiated cells).
• Clinical picture: lesion at the cardioesophageal junction