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== <big>Gastrointestinal Bleeding</big> ==
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{|
<references />{{WikiDoc CMG}}{{AE}}{{MWH}}
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtypes
 
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Explanation
'''''Synonyms and Keywords:''''' Blood loss from GI tract; bloody stool; blood in feces; PR bleeding; gastrointestinal hemorrhage; gastrointestinal hemorrhage; GI bleeding; bright red blood per rectum; BRBPR.
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! style="background: #DCDCDC; text-align: center;" |'''Relapsing remitting'''
== Overview ==
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Gastrointestinal (GI) bleeding is defined as bleeding from any part of GI tract starting from mouth to anus. It can also be called as gastrointestinal hemorrhage. Based on the origin of bleeding it can be classified into upper gastrointestinal bleeding and lower gastrointestinal bleeding. Upper gastrointestinal bleeding (UGIB) is defined as bleeding from the gastrointestinal tract that originates proximal to the ligament of Treitz. Lower gastrointestinal bleeding is defined as blood loss originating distal to the ligament of Treitz. The most common causes of UGIB are peptic ulcer disease and esophageal varices while diverticulosis is the most commonly responsible for lower gastrointestinal bleeding. Clinical presentation includes overt bleeding from the gastrointestinal tract, rapid or slow, either manifested by hematemesis of fresh (blood-streaked to frankly bloody), old ('coffee ground') vomitus, melena and or as frank blood per rectum.
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* Relapsing-remitting multiple sclerosis (RRMS) is defined by acute attacks of [[neurological]] [[dysfunction]] followed by full or partial [[recovery]]. Patient [[History and Physical examination|clinical symptoms]] are stable between the attacks
 
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Common risk factors in the development of GI bleeding include advancing age, previous history of gastrointestinal bleeding, chronic constipation, hematologic disorders, anticoagulants medications, NSAIDs. It is essential to distinguish between lower gastrointestinal bleeding and brisk upper gastrointestinal bleeding as they can present with similar symptoms. Patients with severe bleeding or hemodynamic disturbance require hospitalization and urgent investigation. Treatment depends on the cause and the severity of the bleeding.
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! style="background: #DCDCDC; text-align: center;" |'''Secondary progressive'''
 
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== Types of bleeding ==
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* Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the [[neurological]] [[symptoms]] progressively worsen between the attacks
Bleeding from the gastrointestinal tract can be of the following types:
 
 
 
* '''Hematemesis''': Vomiting fresh red blood.
 
* '''Coffee ground emesis''': Vomiting of altered black blood.
 
* '''Melena''': Passage of black tarry stools.
 
* '''Hematochezia''': Passage of red blood per rectum (usually due to bleeding from the lower gastrointestinal tract but occasionally can be due to massive upper gastrointestinal bleeding).
 
* '''Rebleeding''': Defined as fresh hematochezia and/or melena associated with the development of shock (pulse greater than 100 beats/min, systolic pressure less than 100 mm Hg), a fall in CVP greater than 5 mm Hg, or a reduction in hemoglobin concentration greater than 20 g/l over 24 hours. Rebleeding should always be confirmed by endoscopy.
 
 
 
== Causes ==
 
{| class="wikitable"
 
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!Gastrointestinal Bleeding
 
!Lethal Causes
 
!Common causes
 
!Less Common causes
 
 
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|Upper gastrointestinal bleeding
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! style="background: #DCDCDC; text-align: center;" |'''Primary progressive'''
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| style="background: #F5F5F5;" |
* Anthrax
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* Primary progressive multiple sclerosis (PPMS) is defined by continuously worsening of [[neurological]] [[dysfunction]] with no distinct attacks and [[remission]]<nowiki/>s
* Ebola virus
 
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* Duodenal ulcer
 
* Esophagitis
 
* Esophageal varices
 
* Gastric tumors
 
* Gastric ulcer
 
* Gastritis
 
* Mallory-Weiss Syndrome
 
* Peptic ulcer
 
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* Gastric cancer
 
* Esophageal Tumors
 
* Esophagitis
 
* Gastric erosions/gastropathy
 
* Dieulafoy lesions
 
* Gastric antral vascular ectasia
 
 
|-
 
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|Lower gastrointestinal bleeding
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! style="background: #DCDCDC; text-align: center;" |'''Progressive relapsing'''
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* Diverticulosis
 
* Vascular ectasias
 
* Ischemic colitis
 
* Colorectal malignancy
 
* Hemorrhoids
 
* Anal fissures
 
* Crohn's disease
 
* Ulcerative colitis
 
* Infectious colitis
 
* Colonic polyps
 
* Radiation proctitis
 
* Rectal varices
 
* Stercoral ulceration
 
* Meckel diverticulum
 
* Intussusception
 
* Henoch-Scholein Purpura (HSP)
 
 
|}
 
|}
  
== Classification ==
 
The following flow chart elobarates the classification of gastrointestinal bleeding:
 
  
{{Family tree/start}}
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Table 1: A few milestones in narcolepsy research and therapy
{{Family tree||||||||||||||||||||A01||||||||||A01= '''Gastointestinal'''<br> '''bleeding'''}}
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1877 First description in the medical literature (100)
{{Family tree|||||||||||||||||||||!|||||||||||}}
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1880 Gelineau called the disorder “narcolepsy” (28)
{{Family tree|||||||||||||,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.||||||}}
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1902 Loewenfeld coined the term “cataplexy” (53)
{{Family tree|||||||||||||!|||||||||||||||||||!||||||}}
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1935 First use of amphetamines in the treatment of narcolepsy (87)
{{Family tree|||||||||||||!|||||||||||||||||||!||||||}}
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1960 Description of Sleep Onset REM periods in a narcoleptic subject (99)
{{Family tree||||||||||||B01|||||||||||||||||B02|||||||B01= '''Upper GI bleeding'''|B02= '''Lower GI bleeding'''}}
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1970 Description of the Multiple Latency Test (15, 90)
{{Family tree|||||||||||||!|||||||||||||||||||!||||||}}
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1973 First report of a narcoleptic dog (47, 72)
{{Family tree||||||||||||C01|||||||||||||||||C02|||||C01= Based on blood loss|C02= Based on severity of blood loss}}
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1983 Association of narcolepsy with HLA-DR2 (37)
{{Family tree|||||||,|-|-|-|-|-|+|-|-|-|-|-|.|||||||,|-|-|-|-|-|+|-|-|-|-|-|.||}}
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1985 Monoaminergic and cholinergic imbalance in narcolepsy (7, 80)
{{Family tree|||||D01|||||D02||||D03|||||D04||||D05|||||D06|||||||D01= Overt|D02= Occult|D03= Obscure|D04= Severe|D05= Moderate|D06= Occult}}
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1992 Association of narcolepsy with HLA-DQB1*0602 (56, 63)
{{Family tree|||||||!||||||!||||||!|||||||!||||||!||||||!|}}
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1998 Identification of hypocretins/orexins and their receptors (18, 93)
{{Family tree|||||E01|||||E02||||E03|||||E04||||E05|||||E06|||||||||||E01= Hematemesis Coffee-ground emesis Melena|E02= Microscopic Hemorrhage Heme-Occult positive stools|E03= Source is not identified|E04= Hematochezia|E05= Hematochezia|E06= Microscopic Hemorrhage Heme-Occult positive stools}}
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1999 Hypocretin mutations cause narcolepsy in mice and dogs (16, 51)
{{Family tree||||||||||||||||||||||||||||||}}
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2000 Human narcolepsy is also associated with an hypocretin deficiency (81)
{{Family tree||||||||||||||||||||||||||||||}}
 
{{Family tree||||||||||||||||||||||||||||||}}
 
{{Family tree||||||||||||||||||||||||||||||}}
 
{{Family tree||||||||||||||||||||||||||||||}}
 
{{Family tree/end}}
 

Latest revision as of 15:08, 2 August 2020


Subtypes Explanation
Relapsing remitting
Secondary progressive
  • Patient with long term RRMS can switch to secondary relapsing multiple sclerosis (SPMS) when the neurological symptoms progressively worsen between the attacks
Primary progressive
Progressive relapsing


Table 1: A few milestones in narcolepsy research and therapy 1877 First description in the medical literature (100) 1880 Gelineau called the disorder “narcolepsy” (28) 1902 Loewenfeld coined the term “cataplexy” (53) 1935 First use of amphetamines in the treatment of narcolepsy (87) 1960 Description of Sleep Onset REM periods in a narcoleptic subject (99) 1970 Description of the Multiple Latency Test (15, 90) 1973 First report of a narcoleptic dog (47, 72) 1983 Association of narcolepsy with HLA-DR2 (37) 1985 Monoaminergic and cholinergic imbalance in narcolepsy (7, 80) 1992 Association of narcolepsy with HLA-DQB1*0602 (56, 63) 1998 Identification of hypocretins/orexins and their receptors (18, 93) 1999 Hypocretin mutations cause narcolepsy in mice and dogs (16, 51) 2000 Human narcolepsy is also associated with an hypocretin deficiency (81)