Documente Academic
Documente Profesional
Documente Cultură
digestiva
inferioara
ETIOLOGIE
Differential Diagnosis of Lower Gastrointestinal Hemorrhage
COLONIC BLEEDING (95%) % SMALL BOWEL BLEEDING (5%)
Diverticular disease 30-40 Angiodysplasias
Ischemia 5-10 Erosions or ulcers (potassium, NSAIDs)
Anorectal disease 5-15 Crohn's disease
Neoplasia 5-10 Radiation
Infectious colitis 3-8 Meckel's diverticulum
Postpolypectomy 3-7 Neoplasia
Inflammatory bowel disease 3-4 Aortoenteric fistula
Angiodysplasia 3
Radiation colitis/proctitis 1-3
Other 1-5
Unknown 10-25
Prezentare clinica
Hemoleucograma
completa
Hb, Ht, Tr
Coagulare
Functie plachetara
deficitara?
+ altele in functie de
patologia asociata
Stratificarea riscurilor
Initial Emergency Department Risk Stratification for Patients with Gastrointestinal
Bleeding
Low Risk Moderate Risk High Risk
Age <60 Age >60
Initial SBP 100 mm Initial SBP <100 mm Persistent SBP <100 mm Hg
Hg Hg
Normal vitals for 1 hr Mild ongoing Persistent moderate/severe
tachycardia for 1 hr tachycardia
No transfusion Transfusions required Transfusion required >4 U
requirement 4 U
No active major Stable major comorbid Unstable major comorbid diseases
comorbid diseases diseases
No liver disease Mild liver diseasePT Decompensated liver diseasei.e.,
normal or near-normal coagulopathy, ascites,
encephalopathy
No moderate-risk or No high-risk clinical
high-risk clinical features
features
Stratificare a riscului
Factori de risc independeti pentru
severitatea HDI acute
Hipotensiune
Tahicardia,
Sincopa,
Singerare in primele 4 ore de la prezentare
Consum de aspirina
Mai mult de doua comorbiditati
LOCALIZARE
Conteaza: durata, frecventa si culoarea
singelui din scaun
APP
Antecedente de constipatie sau diaree
Cunoscut c diverticuloaza (singerare
diverticulara)
Radioterapie anterioare (enterita radica)
Polipectomie recenta (singerare de pe transa)
Boli cardiovasculare/hipotensiune (colita
ischemica)
Istoric familial de cancer
LOCALIZARE
Pacientulcontinua sa
singereze si este instabil
hemodinamic
Scan vs colonoscopie
COLONOSCOPIE