[Изображения доступны только зарегистрированным пользователям]
Differential Diagnosis of Gastrointestinal (GI) Bleeding Based
on Clinical Presentation
Hematemesis
● Swallowed blood
Epistaxis, sore throat, breast feeding, dental work, or tonsillectomy
● Vitamin K deficiency in neonate
● Erosive esophagitis
● Mallory-Weiss tear
● Hemorrhagic gastritis
Trauma, surgery, burns, or severe systemic stress (patients in intensive care units)
● Reactive gastritis
Nonsteroidal anti-inflammatory drugs (NSAID gastropathy), alcoholic gastritis, cocaine ingestion, ingestion of caustic
substances, stress, mechanical trauma, viral infection, Crohn disease, vasculitis (Henoch-Scho¨nlein), radiation, bile
reflux, bezoar, hiatal hernia, prolapse of the gastroesophageal junction, or congestive gastropathy (associated with
portal hypertension)
● Peptic ulcer
● Variceal bleeding: associated with portal hypertension
● Submucosal masses
Lipoma, stromal tumors, duplication
● Vascular malformation
Angiodysplasia, hemangioma, Dieulafoy lesion
● Hemobilia
Hematochezia, Melena
● Intestinal ischemia
Complicating intussusception, mid-gut volvulus, incarcerated hernia, or mesenteric thrombosis
● Meckel diverticulum
● Upper GI source: see hematemesis
● Vasculitis
Henoch-Scho¨nlein purpura
● Sloughed polyp
● Intestinal or colonic ulcer
NSAID gastropathy, Crohn disease
● Ulcerative colitis
● Vascular malformation
Rectal Bleeding With Signs of Colitis (Bloody Diarrhea, Tenesmus, Nighttime Stooling)
● Infectious colitis
Consider Salmonella, Shigella, Yersinia enterocolitica, Campylobacter jejuni, Escherichia coli O157:H7, Aeromonas
hydrophilia, Klebsiella oxytoca, Clostridium difficile, Neisseria gonorrhea, cytomegalovirus, Entamoeba histolytica,
Trichuris trichiura
● Hemolytic-uremic syndrome
● Necrotizing enterocolitis
● Eosinophilic proctocolitis
● Inflammatory bowel disease
Ulcerative colitis, Crohn disease
Rectal Bleeding With Normal Stool Pattern
● Juvenile polyp
● Nodular lymphoid hyperplasia
● Eosinophilic colitis
● Inflammatory bowel disease
● Vascular malformation
Bright Red Blood Coating Normal or Hard Stool
● Anal fissure
● Beta-hemolytic streptococcal cryptitis
● Ulcerative proctitis
● Rectal prolapse
● Solitary rectal ulcer
● Internal hemorrhoids
Occult GI Blood Loss
● Esophagitis
● Reactive gastritis
● Acid peptic disease
● Eosinophilic gastroenteritis, colitis
● Celiac disease
● Inflammatory bowel disease
● Polyposis
● Meckel diverticulum
● Vascular malformation
Вот эта таблица. про которую говорила Ирина.