How to Differentiate Sites of Gastrointestinal Bleeding in Patients with Hematochezia by Using Clinical Factors?

Abstract

Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes may be due to upper (UGIB) or lower (LGIB) gastrointestinal tract bleeding. Here, clinical factors were studied to differentiate sites of bleeding in patients with hematochezia. All patients with an age of more than 18 years who were diagnosed with GIB at the ED, Ramathibodi Hospital, Thailand were enrolled. Patients who presented with hematochezia and received complete workups to identify causes of bleeding were studied and categorized as being in the UGIB or LGIB groups. There were 1,854 patients who presented with GIB at the ED. Of those, 76 patients presented with hematochezia; 30 patients were in the UGIB group, while 43 patients were in the LGIB group. Clinical variables between both groups were mostly comparable. Three clinical factors were significantly associated with UGIB causes in patients with hematochezia including systolic blood pressure, hematocrit level, and BUN/Cr ratio. The adjusted odds ratios for all three factors were 0.725 (per 5 mmHg increase), 0.751 (per 3% increase), and 1.11 (per unit increase). Physicians at the ED could use these clinical factors as a guide for further investigation in patients who presented with hematochezia.

Study of Aetiology, Clinical Profile and Endoscopic Findings of Patients With Upper Gastrointestinal Bleeding- A Study From Rural Base Multispecialty Teaching Hospital

“…After initial hemodynamic stabilisation and routine investigations, were subjected to upper GI endoscopy to determine the aetiology. 4 Endoscopy was done by using 2% lignocaine spray into pharynx. All other relevant investigations which were needed for comprehensive diagnosis and management was carried out.…”

“…Patient may present commonly with hematemesis and/or melena while rarely with hematochezia. 2,3,4 Patients may present with acute bleeding and may have life threatening shock and may die because of it. 3 In India, especially from rural setup, patients may go to primary or secondary health centre where facility of endoscopic services may not be available and after resuscitation may be referred to tertiary care centre/endoscopic centre for further evaluation and management or else may come directly to such a facility setting hospital.…”

Upper Gastrointestinal Bleeding

“…The protein is transported to the liver and metabolized via the urea cycle leading to increase urea production. 6,7 Gastric lavage: prior to an endoscopy, a quick diagnostic test that can be employed in the emergency room is the nasogastric tube (NGT) lavage. This consists of instilling 200 to 300 mL of warm saline via a nasogastric tube and inspecting the aspirate for blood or bile.…”

Management of Acute Upper Gastrointestinal Bleeding: An Update for the General Physician

“…In up to 20% of cases, AUGIB may mimic lower gastrointestinal bleeding. 9 Features that predict AUGIB in cases of haematochezia include haemodynamic instability, increased serum urea:creatinine ratio, and reduced haematocrit. 9 The diagnosis is confi rmed with endoscopy, which also serves to provide a therapeutic intervention.…”

“…9 Features that predict AUGIB in cases of haematochezia include haemodynamic instability, increased serum urea:creatinine ratio, and reduced haematocrit. 9 The diagnosis is confi rmed with endoscopy, which also serves to provide a therapeutic intervention. Based on endoscopic diagnoses from the 2007 audit, 5 the aetiologies of AUGIB are summarised in Figure 1.…”