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Harrison's Principles of Internal Medicine, 18e
| Part 2. Cardinal Manifestations and Presentation of Diseases > Section 6. Alterations in Gastrointestinal Function > |
Chapter 41. Gastrointestinal Bleeding
Sections: Gastrointestinal Bleeding: Introduction, Further Readings.
Topics Discussed: gastrointestinal bleeding.
Excerpt:"Bleeding from the gastrointestinal (GI) tract may present in five ways. Hematemesis is vomitus of red blood or "coffee-grounds" material. Melena is black, tarry, foul-smelling stool. Hematochezia is the passage of bright red or maroon blood from the rectum. Occult GI bleeding (GIB) may be identified in the absence of overt bleeding by a fecal occult blood test or the presence of iron deficiency. Finally, patients may present only with symptoms of blood loss or anemia such as lightheadedness, syncope, angina, or dyspnea.(Table 41-1) The annual incidence of hospital admissions for upper GIB (UGIB) in the United States and Europe is  0.1%, with a mortality rate of 5–10%. Patients rarely die from exsanguination; rather, they die due to decompensation from other underlying illnesses. The mortality rate for patients <60 years in the absence of major concurrent illness is <1%. Independent predictors of rebleeding and death in patients hospitalized with UGIB include increasing age, comorbidities, and hemodynamic compromise (tachycardia or hypotension).In addition to clinical features, characteristics of an ulcer at endoscopy..."
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