Occult gastrointestinal bleeding and iron deficiency anaemia

Chapter 23 OCCULT GASTROINTESTINAL BLEEDING AND IRON DEFICIENCY ANAEMIA




This chapter concentrates on unexplained or occult gastrointestinal bleeding from the upper gastrointestinal tract and small intestine.




AETIOLOGY


Most causes of occult gastrointestinal bleeding derive from the small intestine. In patients aged 40 years or younger, small intestine tumours, Meckel’s diverticulum, polyposis syndromes and Crohn’s disease are more common. In patients over 40 years of age, arteriovenous malformation (the most common cause overall), neoplasia and Dieulafoy’s malformation are more prevalent. Some of the specific causes of gastrointestinal bleeding are listed below.




Cameron erosions


Linear gastric erosions located at or near the level of the neck of a large diaphragmatic hernia are referred to as Cameron erosions. The diagnosis is made endoscopically following a thorough examination of the hiatal hernia sac. Patients with Cameron ulcers present with acute upper gastrointestinal bleeding (haematemesis or melaena) or chronic blood loss (faecal-occult-blood-test-positive stools or iron deficiency anaemia). The pathogenesis of these lesions is postulated to involve mechanical trauma; with respiratory excursions, the gastric mucosa at the level of the


TABLE 23.1 Aetiology of occult gastrointestinal bleeding















Small intestine











Stomach



Biliary tree
Pancreas
Colon

neck of the hernia rub against adjacent mucosa. The mainstay of medical treatment is acid suppressive therapy. If blood loss is severe or persistent, or if the ulceration of hernia is complicated, surgical repair of the hernia should be considered.



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Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Occult gastrointestinal bleeding and iron deficiency anaemia

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