Lower gastrointestinal haemorrhage

Lower gastrointestinal haemorrhage

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Lower digestive bleeding lesions originated in the small intestine, duodeno-jejunal angle, colon and rectum. They are more rare and usually higher than those not so serious, but I difficult diagnostic problems. Cases related to the small intestine are quite rare in adults, less than 2% of gastrointestinal bleeding and more frequent in children, which are harder to recognize. Transit barytic is somewhat difficult to interpret, because only objective being able celiomezenterica angiography. Among the lesions responsible are registered: benign and malignant tumors, ulcers on heterotopic gastric mucosa-located in Meckel diverticulum, intestine, endocrine or ulcer medication, intestino-mesenteric infarction, Crohn's disease. Colonic causes relates mainly to the right colon lesions, the left colon is manifested by rectoragia. Between injuries are part responsible: benign or malignant tumors, diverticulitis, vascular malformations, ulcerative colitis. The first step in diagnosis is the assertion of low origin of bleeding. For the upper digestive endoscopy and aspiration of gastric hemorrhage are causes of high. Clinical examination will look for associated abdominal pain, this transit-diarrhea disorders. Cough will exclude anal fissure, hemorrhoids, anorectal prolapse or tumor. Diagnosis is specified on the basis of clinical and colonoscopic confirmation is made, arteriography or barium enema. Requiring hospitalization HDI has more than 1% of hospitalizations. Is the major cause of diverticulosis and angiodisplazia. Diverticulosis in 30-50% of cases and 20-30% angiodisplazia. Hemorrhoids are the most common cause in patients younger than 50 years. Symptoms vary from melena HDI, hematochezie, chronic anemia with occult bleeding, until the shock by massive bleeding. The mortality rate varies between 10-20%, and is increased in elderly with comorbidities bolonavii.
Causes and pathogenesis
Diverticulosis is the dominant etiology of HDI. Most diverticuluita occur without associated bleeding, it could increase the risk of bleeding. Diverticula in the colon wall is a sac that develops muscle weakness intro area. Vessels that accompany the muscle lining protruzionata become trapped in diverticol colony and repeated trauma, muscle contraction and relaxation lead to an erosion of their vessels and bleeding. Approximately 75% of the left colon diverticulosis appears. Risk factors for bleeding diverticulitis are: lack of dietary fiber, constipation, old age and NSAID use. Angiodisplazia is also one of the most common causes of HDI. The lesions appear mainly on the proximal colon. These are degenerative lesions that develop in chronic contraction colony which obstruct venous drainage of mucus. While mucosal capillaries become incompetent to form arteriovenous malformations. Massive bleeding because of angiodisplazie are from venous network. Ischemic colitis is caused by hypotension and vasoconstriction, which leads to mucosal friability. They often develop on the left colon and rectum. Patients with comorbidities, arrhythmias and heart failure are more succeptibili. Neoplasms can be represented by polyps or carcinomas. Colon cancer is the predominant cause of bleeding cancer and is responsible for 10% of rectal bleeding in patients older than 50 years. Infectious colitis is caused by Salmonella, Shigella, Campylobacter jejuni, E. Coli 0157: H7 and Entamoeba histolytica. These bacteria cause diarrhea, fever, lower abdominal pain and tenesmus. Idiopathic colitis and Crohn's disease is represented by ilcero hemorrhagic colitis. It can cause diarrhea with blood in 50% of patients, while 4% of them will experience major bleeding. Mucosal lesion is similar to the one found in patients with ischemic colitis, where mucosa is friable, erythematous, edematous and ulcerated. In severe Crohn's disease, inflammatory process may extend to serosal perforation leading to the colony. Colitis induced by irradiation may cause changes in the lining of the singereaza teleangiectazii. Abdominal and pelvic irradiation can lead to complications with ulceration, early post-irradiation or 9-15 months. Other vascular causes of the HDI are: Wegener's disease and polyarteritis nodosum. Anorectal diseases are the hemorrhoids, fistulas, fissures and cause typical intermittent bleeding red blood. AIDS / HIV is a rare cause of HDI. It is due to intestinal opportunistic infections: CMV, idiopathic colonic ulcers, Kaposi's sarcoma and lymphoma. NSAIDs, especially aspirin is a common cause of HDI in the elderly. Aspirin and anticoagulants increase the risk of HDI.