Gastrointestinal bleeding: Pathology review
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Gastrointestinal bleeding: Pathology review
Pathology
Liver, gallbladder and pancreas disorders
Biliary atresia
Crigler-Najjar syndrome
Dubin-Johnson syndrome
Gilbert's syndrome
Rotor syndrome
Acute cholecystitis
Ascending cholangitis
Biliary colic
Cholangiocarcinoma
Chronic cholecystitis
Gallbladder cancer
Gallstone ileus
Gallstones
Alcohol-induced liver disease
Alpha 1-antitrypsin deficiency
Autoimmune hepatitis
Benign liver tumors
Budd-Chiari syndrome
Cholestatic liver disease
Cirrhosis
Hemochromatosis
Hepatic encephalopathy
Hepatitis
Hepatocellular adenoma
Hepatocellular carcinoma
Jaundice
Neonatal hepatitis
Non-alcoholic fatty liver disease
Portal hypertension
Primary biliary cirrhosis
Primary sclerosing cholangitis
Reye syndrome
Wilson disease
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Acute pancreatitis
Chronic pancreatitis
Pancreatic cancer
Pancreatic pseudocyst
Lower gastrointestinal tract disorders
Bowel obstruction
Gallstone ileus
Intestinal adhesions
Volvulus
Colorectal cancer
Colorectal polyps
Familial adenomatous polyposis
Gardner syndrome
Juvenile polyposis syndrome
Peutz-Jeghers syndrome
Gastroschisis
Hirschsprung disease
Imperforate anus
Intestinal atresia
Intestinal malrotation
Intussusception
Meckel diverticulum
Necrotizing enterocolitis
Omphalocele
Abdominal hernias
Femoral hernia
Inguinal hernia
Crohn disease
Microscopic colitis
Ulcerative colitis
Ischemic colitis
Small bowel ischemia and infarction
Celiac disease
Lactose intolerance
Protein losing enteropathy
Short bowel syndrome (NORD)
Small bowel bacterial overgrowth syndrome
Tropical sprue
Whipple's disease
Carcinoid syndrome
Appendicitis
Diverticulosis and diverticulitis
Gastroenteritis
Irritable bowel syndrome
Anal fissure
Anal fistula
Hemorrhoid
Rectal prolapse
Upper gastrointestinal tract disorders
Cleft lip and palate
Congenital diaphragmatic hernia
Esophageal web
Pyloric stenosis
Tracheoesophageal fistula
Achalasia
Barrett esophagus
Boerhaave syndrome
Diffuse esophageal spasm
Eosinophilic esophagitis (NORD)
Esophageal cancer
Gastroesophageal reflux disease (GERD)
Mallory-Weiss syndrome
Plummer-Vinson syndrome
Zenker diverticulum
Cyclic vomiting syndrome
Gastric cancer
Gastric dumping syndrome
Gastritis
Gastroenteritis
Gastroparesis
Peptic ulcer
Aphthous ulcers
Dental abscess
Dental caries disease
Gingivitis and periodontitis
Ludwig angina
Oral cancer
Oral candidiasis
Parotitis
Sialadenitis
Temporomandibular joint dysfunction
Warthin tumor
Gastrointestinal system pathology review
Appendicitis: Pathology review
Cirrhosis: Pathology review
Colorectal polyps and cancer: Pathology review
Congenital gastrointestinal disorders: Pathology review
Diverticular disease: Pathology review
Esophageal disorders: Pathology review
Gallbladder disorders: Pathology review
Gastrointestinal bleeding: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Jaundice: Pathology review
Malabsorption syndromes: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Pancreatitis: Pathology review
Viral hepatitis: Pathology review
Assessments
Gastrointestinal bleeding: Pathology review
USMLE® Step 1 questions
0 / 8 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Sodium | 139 mg/dL |
| Potassium | 3.8 mg/dL |
| Chloride | 100 mg/dL |
| Bicarbonate | 33 mg/dL |
Transcript
Content Reviewers
A 30-year-old male named Joseph came to the emergency department because of sharp chest pain radiating to his back. He recently graduated from medical school and has been celebrating for the past week at local bars. He says that he was drinking to the point of vomiting and blacking out. He thinks his pain began after a particularly intense night of vomiting and retching. His vital signs show no abnormalities. On the other hand, a 54-year-old lawyer called Lance has been noticing blood in his stool for the past 2 weeks. As he describes the problem, he mentions that there are “streaks of bright red blood” on top of the stool and didn’t notice any pain during bowel movements. Also, he reports a marble-sized, soft mass at the anus that can be pushed back into the anal canal. He denies abdominal pain, weight loss, or a history of colon cancer.
Now both people have gastrointestinal bleeding, but with different presentations. Gastrointestinal bleeding can be divided into upper and lower GI bleeding. Upper GI bleeding arises above the ligament of Treitz, also called the suspensory ligament of the duodenum, and it includes bleeding from the esophagus, stomach, or duodenum. Typical presentation includes hematemesis, or vomiting of blood; ‘coffee ground’ vomitus, which suggests that the blood has been oxidized by the acid in the stomach so that the iron in the blood has turned dark; and melena, which refers to black, tarry stools. On the other hand, lower GI bleeding arises below the ligament of Treitz and includes bleeding from the small intestine past the ligament of Treitz, large intestines, rectum, and anus. Typical presentation includes hematochezia, which is fresh blood passing through the anus which may or may not be mixed with stool.
Now, since these individuals are losing blood, they can develop anemia, or they can even become hemodynamically unstable. In mild hypovolemia, when they lose less than 15% of the blood volume, these individuals can experience resting tachycardia. In moderate hypovolemia, when they lose from 15% to 40% of the blood volume, they can experience orthostatic hypotension; and finally, in severe hypovolemia, when they lose over 40% of the blood volume, these individuals will develop hypotension.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book" Elsevier Health Sciences (2013)
- "Acute Gastrointestinal Bleeding" Annals of Internal Medicine (2013)
- "The Overall Approach to the Management of Upper Gastrointestinal Bleeding" Gastrointestinal Endoscopy Clinics of North America (2011)
- "Diagnosis of gastrointestinal bleeding: A practical guide for clinicians" World Journal of Gastrointestinal Pathophysiology (2014)
- "Hemorrhoids" Clinics in Colon and Rectal Surgery (2011)
- "Management of Ischemic Colitis" Clinics in Colon and Rectal Surgery (2012)
- "Management of Colonic Volvulus" Clinics in Colon and Rectal Surgery (2012)
- "Intestinal Intussusception: Etiology, Diagnosis, and Treatment" Clinics in Colon and Rectal Surgery (2016)
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