Documente Academic
Documente Profesional
Documente Cultură
HDInferioara
HDInferioara
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 – atentie la patologia
hepatica cronica
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 disease—PT Decompensated liver disease—i.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 independenti 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 cu diverticuloza (singerare
diverticulara)
Radioterapie anterioara (enterita/colita radica)
Polipectomie recenta (singerare de pe transa)
Boli cardiovasculare/hipotensiune (colita
ischemica)
Istoric familial de cancer
LOCALIZARE
Tratament local
Pregatirea este o problema
Scenariu clinic