The characteristic black colour of the stool is secondary to the presence of hemoglobin that has been altered by digestive enzymes and intestinal bacteria. Upper GI bleeds typically present with the patient reporting either frank red or coffee-ground emesis, upper abdominal pain, and melena. This anatomic distinction is important as it affects the clinical signs and symptoms associated with upper and lower GI bleeds. Conversely, lower GI bleeding is defined as bleeding from a source within the GIT that is located below the ligament of Treitz. It marks the transition zone between the upper and lower GI tracts. This structure connects the duodenum, jejunum, and duodenojejunal flexure to the connective tissues surrounding the superior mesenteric artery and celiac artery. What is the ligament of Treitz, you ask? Well, perhaps it is more helpful to know the name that anatomists actually call it – the suspensory muscle of the duodenum. Upper GI bleeding is defined as bleeding from a source within the GIT that is located above the ligament of Treitz. We are strapping on our medical school hats today with this one. Core Questions: Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic locationĪlright, everyone. Last, we end the episode with those classic quick snappers you have all come to love that you can stow away in the back of your mind until it comes time to crush your next on-shift quiz. We will next review Rosen’s algorithm on the initial stabilization of these patients. After that, we will cover an approach to the history, physical exam, and ancillary testing strategies that you can use on your next shift. Today’s episode will give you all of the information you will need to handle that case like the boss you are! First, we will go about speaking to the anatomic definitions you need to know to differentiate between UGI and LGI bleeds. I know, yikes.įor those of you who worry that the next hypotensive GI bleed to walk through your ED doors will strain your knowledge, have no fear – CRACKCast is here. LGI bleeds, while less lethal, still carry significant risk for death (4%). The scary thing is, despite the myriad of advancements made in intensive care, endoscopy, and surgery, the mortality rate for UGI bleeds has not budged for decades. In fact, the mortality rate for UGI bleeds is not insignificant, weighing in at a whopping 15%. If you are still junior (or just verrrrrry lucky), you may have not yet seen how “down with the sickness” these patients can be. And while we have all met the patient with black stools, we may have not all experienced the full spectrum of illness that this pathology can create. Some of medicine’s most interesting stories stem from discoveries around this pathology. Shownotes – PDF Here Rosen’s in PerspectiveĪhhhhh, the GI bleed a problem that is as old as time. Josh Butcher for joining us for this episode! With this review we hope to streamline your approach to patient’s losing their circulatory volume from their GI tract to avoid the bloody mess. This updated episode of CRACKCast covers Rosen’s Chapter 27 (9th Ed.) regarding gastrointestinal bleeding.
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