​There are too many causes of "digestive tract bleeding", can't remember?

Only for medical professionals to read the reference dry goods! The clinical manifestations of gastrointestinal bleeding are different, and the causes are also diverse.

According to the amount and speed of blood loss, gastrointestinal bleeding can be divided into chronic occult bleeding, chronic overt bleeding and acute bleeding.
This is usually the first image judgment at the first diagnosis, but its specific causes need to be further understood.

Gastrointestinal bleeding can be caused by inflammation, mechanical damage, vascular disease, tumors and other factors of the digestive tract itself, and can also be caused by diseases of adjacent organs and systemic diseases involving the digestive tract.

According to the bleeding site, with the ligament of flexion as the boundary, it is divided into upper gastrointestinal bleeding and lower gastrointestinal bleeding.

Massive bleeding in the gastrointestinal tract in a short period of time is called acute hemorrhage, often accompanied by acute peripheral circulatory disorders, and the mortality rate accounts for about 10%.

80% of upper gastrointestinal bleeding is self-limiting, and the mortality rate of lower gastrointestinal bleeding generally does not exceed 5%.

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Although endoscopy is the preferred method for locating and qualitative diagnosis of gastrointestinal bleeding, its diagnosis accuracy rate is 80%~94%, which can solve 90% of the etiological diagnosis of gastrointestinal bleeding, but in the basic level lacking endoscopic conditions It is also important for medical institutions to judge the cause of bleeding through clinical manifestations and other auxiliary examinations.

It should be noted that small intestinal bleeding is a relatively rare disease, accounting for about 5% to 10% of gastrointestinal bleeding.
Small intestinal bleeding is considered only after routine upper gastrointestinal endoscopy and lower gastrointestinal endoscopy.
The bleeding is usually Between the distal end of Vater's ampulla and the proximal end of the ileocecal valve.

In addition, there are unexplained gastrointestinal bleeding, which refers to continuous or recurring bleeding whose cause cannot be determined by routine gastrointestinal endoscopy, X-ray small bowel barium examination or small bowel CT.

In addition to the judgment of the cause, it is more important to make a correct and rapid assessment of the patient, especially the estimation of the severity of bleeding and the judgment of the peripheral circulatory state, as well as the judgment of whether the bleeding has stopped, which determines the subsequent clinical decision-making.

The more high-risk risk factors such as hemodynamic instability, persistent bleeding, age older than 60 years, more comorbidities, elevated serum creatinine, and severe anemia, the more serious the condition, and more active rescue and treatment methods are required.

References: [1] Practical Internal Medicine (15th Edition), People's Medical Publishing House.
Lin Guowei, Wang Jiyao, Ge Junbo editors.
[2] Wang Lingna, Huang Peng.
Analysis of the cause of hematochezia in the elderly[J].
Chinese and Foreign Medical Research ,2015,13(30):108-109.
[3] Chinese Medical Association Endoscopy Branch.
Guidelines for the diagnosis and treatment of lower gastrointestinal bleeding (2020)[J].
China Medical Journal, 2020,55(10):1068-1076 .