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GASTROINTESTINAL BLEEDING |
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UPPER GASTROINTESTINAL BLEEDING (haematemesis and/or melaena): |
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peptic ulceration (gastric/duodenal, including stress ulcers)erosive gastritis/duodenitis (alcohol, NSAIDs)oesophageal varices (liver cirrhosis)oesophageal lacerations (Mallory-Weiss syndrome)swallowed blood from nasal/oral cavities or from haemoptysis |
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rarer causes: |
oesophagitis upper gi tumours bleeding diatheses foreign body eg. fishbonepseudoxanthoma elasticum Peutz-Jeghers syndrome angiodysplasia hereditary haemorrhagic telangiectasia parasites, eg. hookwormMenetrier's disease [gastric rugal hypertrophy] |
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haematobilia: |
hepatobiliary tumours following sphincterotomy at ERCP Dieulafuoy lesion trauma (penetrating injuries) |
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LOWER GASTROINTESTINAL BLEEDING (melaena if slow bleed and proximal lesion; fresh blood if massive bleed or distal lesion): |
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haemorrhoids (small amounts of fresh blood)diverticular disease (usually large amounts of fresh blood)tumours eg. colorectal carcinoma, haemangiomainflammatory bowel disease (especially UC)angiodysplasia (usually large amounts of fresh blood)intestinal haemangiomas blue rubber-bleb naevi ischaemic colitis radiation ileitis colonic polyps eg. familial polyposisanal fissure Peutz-Jeghers syndrome Meckel's diverticulitis dysentery (amoebic and bacillary)severe gastroenteritis hereditary haemorrhagic telangiectasia endometriosis (cyclical bleeding)hookworm bleeding diatheses intussusception volvulus uraemic colitis solitary rectal ulcer syndrome trauma foreign body |
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