Gastroenterology Book

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Gastrointestinal Bleeding

Aka: Gastrointestinal Bleeding, Acute Gastrointestinal Hemorrhage, Acute Gastrointestinal Bleeding Management, Gastrointestinal Bleeding Management, GI Bleed, Hematochezia, Bright Red Blood Per Rectum, Melena, Maroon Stool
  1. See Also
    1. Gastrointestinal Occult Bleeding
  2. Definitions
    1. Overt Gastrointestinal Bleeding
      1. Visible Gastrointestinal Bleeding (e.g. Hematemesis, Hematochezia)
    2. Obscure Gastrointestinal Bleeding
      1. Recurrent Gastrointestinal Bleeding without a source identified despite diagnostic evaluation
      2. Most commonly associated with Small Intestinal Bleeding
    3. Occult Gastrointestinal Bleeding
      1. Gastrointestinal Bleeding not visible on stool examination
      2. Presents with occult occult blood test positive (e.g. guiaic stool testing or FIT Testing) or Iron Deficiency Anemia
    4. Hematochezia (Bright Red Blood Per Rectum)
      1. Grossly bloody or dark red stool that usually correlates with Lower GI Bleeding
      2. Differentiate from Maroon Stool which is associated with brisk Upper Gastrointestinal Bleeding
    5. Melana (Black Stool)
      1. Black stool is typically associated with Upper GI Bleeding, with heavier bleeding suggested by tarry black stool
      2. Lower GI Bleeding is responsible for one third of black stool cases
    6. Maroon Stool
      1. Suggests rapid Upper GI Bleeding
  3. Causes: Sources of acute Gastrointestinal Bleeding
    1. Upper Gastrointestinal Bleeding (70%)
      1. Annual Incidence (U.S.): 100-200 per 100,000
    2. Small Intestinal Bleeding (5%)
    3. Lower Gastrointestinal Bleeding (24%)
      1. Annual Incidence (U.S.): 20-27 per 100,000
  4. Exam: Vital Signs
    1. Orthostatic Blood Pressure and Pulse (variable efficacy)
    2. Blood Pressure
      1. Hypotension may be an ominous sign of impending cardiovascular collapse
    3. Heart Rate
      1. Tachycardia in most cases
      2. Paradoxical Bradycardia causes
        1. Beta Blockers or nitrates
        2. Vagal response due to GI Bleed
    4. Oxygen Saturation
    5. Follow Urine Output
  5. Signs: Identify gastrointestinal source of blood
    1. Signs of upper GI sources of blood (>75% of GI Bleeds)
      1. Unstable patients are most likely to be from Upper GI Bleeding
      2. Hematemesis (present in 50% of Upper GI Bleed)
      3. Nasogastric aspirate positive for blood
      4. Melena (Black tarry stool)
        1. Black tarry stool requires 150 to 200 cc blood
        2. Black non-tarry stool requires 60 cc blood
        3. Blood must be in GI tract 8 hours to turn black
        4. Stool remains black for several days in GI tract
        5. Melana source
          1. Present in 70% of Upper GI Bleeding
          2. Present in 33% of Lower GI Bleeding
    2. Signs of lower GI sources of blood
      1. Blood per Rectum occurs with any GI source
      2. Hematochezia (seen in 80% of all GI Bleeding)
        1. Grossly bloody or dark red stool
        2. Usually correlates with Lower GI Bleeding
        3. Brisk Upper GI Bleeding may result in Maroon Stool (11%)
      3. Blood in toilet (e.g. Hemorrhoid source)
        1. Toilet water may appear bright red from 5 cc blood
  6. Evaluation
    1. Upper GI Bleeding evaluation
      1. See Upper GI Bleed
      2. See Upper GI Bleeding Score
      3. See Upper GI Endoscopic Evaluation of Bleeding
      4. Indication
        1. Hematemesis (or blood on nasogastric aspirate)
        2. Melanotic stool or in cases of brisk Upper GI Bleeding, maroon
        3. Upper GI Bleed more likely in unstable patients
      5. Common Causes
        1. Duodenal Ulcer, Gastric Ulcer or Gastritis
        2. Esophageal Varices
        3. Esophagitis
    2. Lower GI Bleeding evaluation
      1. See Lower GI Bleed
      2. See Colonoscopy in GI Bleeding
      3. Indication
        1. No Hematemesis or nasogastric lavage/aspirate with bile but no blood
        2. Bright Red Blood Per Rectum
      4. Common Causes
        1. Diverticular Bleeding
        2. Arteriovenous malformations
        3. Colon Polyps or Colorectal Cancer
  7. Labs
    1. Complete Blood Count
      1. Baseline Hemoglobin (trails bleeding by 24 hours)
    2. Blood Type and Cross-match
    3. Coagulation Factors
      1. Prothrombin Time
      2. Platelet Count
  8. Diagnostics
    1. Electrocardiogram
      1. Monitor for cardiac ischemia
  9. Management: Acute
    1. ABC Management
      1. Oxygen
      2. Intravenous Access
        1. Two large bore IV (14-16 gauge)
        2. Start with isotonic saline (NS or LR)
      3. Intravenous FluidResuscitation
        1. Massive GI Bleed
          1. See Massive Hemorrhage
          2. Replace blood with blood
          3. Start with universal donor blood (O- in premenopausal women, O+ in men)
          4. Transfuse type specific blood when available
          5. Replace 1 unit plasma per unit pRBC and 1 unit apheresis platelets for every 8 units pRBC
        2. Non-massive GI Bleed
          1. Crystalloid 10 cc/kg boluses until stable
          2. Reassess after 3 boluses (30 cc/kg)
          3. Consider transfusion for unstable after 3 boluses
      4. Endotracheal Intubation
        1. Indications
          1. Altered Mental Status
          2. Massive Upper GI Bleeding
            1. Controls airway to prevent aspiration
            2. Confirms source (via orogastric or Nasogastric Tube)
        2. Technique
          1. Endotracheal Intubation Preoxygenation is key
            1. Minimal reserve due to acute blood loss
    2. Intensive Care Unit admission indications
      1. Significant bleeding
      2. Hemodynamically unstable
    3. Transfusion Packed Red Blood Cells
      1. Indications
        1. Hemoglobin 8 g/dl or Hematocrit 25%
        2. Brisk active bleeding (replace blood with blood)
        3. Cardiopulmonary symptoms
        4. Cardiopulmonary comorbidity
      2. Do not base transfusion in acute bleeding on labs
        1. Hemoglobin And Hematocrit lag bleeding by 24 hours
        2. Active unstable bleeding requires Blood Products
        3. Base transfusion on Hemodynamic status
        4. Base on response to crystalloid (after 30 cc/kg)
        5. In Massive Hemorrhage, replace blood with blood as soon as universal donor blood available
          1. Replace 1 unit plasma per unit pRBC
          2. Replace 1 unit apheresis platelets for every 8 units pRBC
      3. Once stabilized blood count may direct transfusion
        1. Transfuse for Hemoglobin 7 g/dl (Hematocrit 25%)
        2. Maintain Hemoglobin At 9 g/dl after transfusion
        3. Expect 1 g/dl Hemoglobin increase/unit transfused
        4. Expect 3% Hematocrit increase/unit transfused
        5. Goal is not a specific Blood Pressure, but rather improved mental status and Urine Output
      4. In non-exsanguinating Upper GI Hemorrhage
        1. Delaying transfusion until Hemoglobin <7.0 is associated with better outcomes
        2. Restrictive transfusion strategy had better outcomes regardless of cause (peptic ulcer or Cirrhosis)
        3. Villaneuva (2013) N Engl J Med 368(1): 11-21 [PubMed]
      5. Replace Coagulation Factors
        1. Consider Prothrombin Complex Concentrate (PCC 4) as an alternative to FFP
        2. Fresh Frozen Plasma (FFP) indications
          1. Exsanguinating Hemorrhage (transfuse RBC and FFP in 1:1 ratio)
          2. INR (Prothrombin Time) prolonged >1.5 times normal
            1. INR may be remarkably normal despite severe Coagulopathy (e.g. Cirrhosis)
        3. DDAVP
          1. Consider for Massive Hemorrhage in Renal Failure
    4. Transfusion platelet indications
      1. Platelet Count <50,000/mm3
      2. Aspirin or NSAID related GI Bleeding (no evidence)
      3. Clopidogrel (Plavix) use
      4. Cirrhosis (No evidence)
    5. Other measures in exsanguinating Hemorrhage
      1. Tranexamic Acid
  10. Management: Based on Bleeding site
    1. Upper GI Bleed
      1. See Upper GI Bleeding
      2. If unclear source, assume Upper GI Bleeding, especially if patient is unstable
        1. Upper GI Bleeds cause >75% of GI Bleeds and have a much higher mortality, worse prognosis
      3. In massive GI Bleeding or unstable patient
        1. Focus on possible peptic ulcer and Esophageal Varices as most likely source
    2. Lower GI Bleed
      1. See Lower GI Bleeding
      2. Relatively low mortality of 4% compared with Upper GI Bleed
  11. Complications
    1. Cardiac ischemia
    2. Acute Renal Failure
    3. Acute Respiratory Distress Syndrome (ARDS)
  12. References
    1. Spangler, Swadron, Mason and Herbert (2016) EM:Rap C3, p. 1-11
    2. Henneman in Marx (2002) Rosen's Emergency, p 194-200
    3. Fallah (2000) Med Clin North Am 84(5):1183-208 [PubMed]
    4. Terdiman (1998) Postgrad Med 103(6):43-64 [PubMed]

Gastrointestinal Hemorrhage (C0017181)

Definition (MSHCZE) Krvácení do některé části GASTROINTESTINÁLNÍHO TRAKTU (od EZOFÁGU po REKTUM).
Definition (MEDLINEPLUS)

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Signs of bleeding in the digestive tract depend where it is and how much bleeding there is.

Signs of bleeding in the upper digestive tract include

  • Bright red blood in vomit
  • Vomit that looks like coffee grounds
  • Black or tarry stool
  • Dark blood mixed with stool

Signs of bleeding in the lower digestive tract include

  • Black or tarry stool
  • Dark blood mixed with stool
  • Stool mixed or coated with bright red blood

GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus.

The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. A type of endoscopy called colonoscopy looks at the large intestine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) Bleeding originating from any part of the gastrointestinal tract.
Definition (MSH) Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM.
Definition (CSP) escape of blood from the vessels, or bleeding, in the gastrointestinal tract.
Concepts Pathologic Function (T046)
MSH D006471
ICD9 578.9, 578
ICD10 K92.2
SnomedCT 155840004, 266477005, 197475002, 155837004, 197471006, 74474003
English Gastrointestinal Hemorrhage, Gastrointestinal Hemorrhages, Hemorrhage, Gastrointestinal, Hemorrhage of gastrointestinal tract, GASTROINTESTINAL TRACT BLEED NOS, GI HAEMORRHAGE, GI HEMORRHAGE, gastrointestinal hemorrhage, GI - Gastrointest haemorrhag, GIT - Gastroin tract haemorrh, Hemorrhage of gastrointestinal tract, unspecified, GIT haemorrhage NOS, GIT haemorrhage unspecified, GIT hemorrhage NOS, GIT hemorrhage unspecified, Gastrointestinal haemorrhage unspecified, Gastrointestinal haemorrhage, unspecified, Gastrointestinal hemorrhage unspecified, Gastrointestinal hemorrhage, unspecified, Gastrointestinal tract haemorrhage NOS, Gastrointestinal tract hemorrhage NOS, Gastrointestinal hemorrhage NOS, GIB - Gastrointestin bleeding, GIB - Gastrointestinal bleeding, GIH - Gastrointest haemorrhage, GIH - Gastrointest hemorrhage, gastrointestinal bleeding, gastrointestinal bleeding (diagnosis), Gastro intestinal bleed, Gastro intestinal bleeding, Gastro-intestinal tract bleed, Bleeding gastrointestinal, Gastrointestinal tract bleed (NOS), Gastrointestinal tract bleed NOS, GI bleed, GI tract bleed, Haemorrhage of digestive tract, Hemorrhage of digestive tract, Gastrointestinal haemorrhage NOS, Haemorrhage of gastrointestinal tract, unspecified, Hemorrhage gastrointestinal, Gastrointest hemorr NOS, Gastrointestinal Hemorrhage [Disease/Finding], Bleeding;gastrointestinal, gastrointestinal haemorrhage, gastrointestinal hemorrhages, gi hemorrhage, gi bleed, gastrointestinal bleed, gastro intestinal bleeding, gi bleeding, Gastrointestinal haemorrhages, Gastrointestinal Bleeding, Bleeding, Gastrointestinal, GI Bleeding, Gastrointestinal tract haemorrhage NOS (disorder), Gastrointestinal hemorrhage unspecified (disorder), Gastrointestinal tract hemorrhage NOS (disorder), Gastrointestinal haemorrhage (disorder), Haemorrhage gastrointestinal, GI Bleed, Gastrointestinal Bleed, GI bleeding, Gastrointestinal hemorrhage, GI - Gastrointestinal bleed, GI - Gastrointestinal haemorrhage, GI - Gastrointestinal hemorrhage, GIT - Gastrointestinal tract haemorrhage, GIT - Gastrointestinal tract hemorrhage, Gastrointestinal bleed, Gastrointestinal haemorrhage, Gastrointestinal bleeding, GIH - Gastrointestinal haemorrhage, GIH - Gastrointestinal hemorrhage, GI haemorrhage, GI hemorrhage, Gastrointestinal hemorrhage (disorder), gastrointestinal tract; hemorrhage, gastrointestinal; hemorrhage, gastrostaxis, hemorrhage; gastrointestinal tract, hemorrhage; gastrointestinal, Gastrointestinal bleeding, NOS, Gastrointestinal hemorrhage, NOS, GI bleeding, NOS, GI hemorrhage, NOS, Gastrointestinal hemorrhages
Italian Emorragie gastrointestinali, Emorragia del tratto gastrointestinale, non specificata, Emorragia del tratto gastrointestinale, Sanguinamento gastrointestinale, Emorragia gastrointestinale, NAS, Sanguinamento del tratto gastro-intestinale, Sanguinamento del tratto gastrointestinale (NAS), Sanguinamento del tratto gastrointestinale, NAS, Sanguinamento del tratto gastrointestinale, Emorragia delle vie digerenti, Emorragia gastrointestinale
Dutch maagdarmstelselkanaalbloeding (NAO), bloeding van maagdarmstelselkanaal, niet-gespecificeerd, maagdarmstelselbloeding, GI-bloeding, bloeding van gastro-intestinaal kanaal, niet-gespecificeerd, gastro-intestinaalkanaalbloeding, maagdarmstelselbloeding NAO, bloeding van spijsverteringskanaal, bloeding gastro-intestinaal, bloeding maagdarmstelsel, GI-kanaalbloeding, maagdarmstelselkanaalbloeding NAO, hemorragie maagdarm, bloeding; gastro-intestinaal, bloeding; maagdarmkanaal, gastro-intestinaal; bloeding, maagdarmkanaal; bloeding, Gastro-intestinale bloeding, niet gespecificeerd, gastro-intestinale bloeding, maagdarmstelselbloedingen, Bloeding, gastro-intestinale, Gastro-intestinale bloeding, Intestinale bloeding, gastro-
French Saignement gastro-intestinal, Saignement GI, Saignement des voies gastrointestinales SAI, Hémorragie des voies gastrointestinales, non précisée, Saign gastro-intestinal, Saign gastrointestinal, Hémorragie des voies digestives, Hémorragie du tractus gastro-intestinal, non précisée, Hémorragie du tractus digestif, Hémorragie gastro-intestinale SAI, Saignement des voies GI, Saignement des voies gastro-intestinales, Saignement des voies gastro-intestinales SAI, HEMORRAGIE DIGESTIVE SAI, HEMORRAGIE GASTRO-INTESTINALE, Hémorragies gastro-intestinales, Hémorragie gastrointestinale, Hémorragie gastro-intestinale
German gastrointestinale Blutung, GI Blutung, Blutung des Verdauungstrakts, Blutung, gastrointestinal, Blutung des Verdauungstrakts, unspezifisch, GI-Trakt-Blutung, Gastrointestinaltrakt-Blutung, gastrointestinale Blutung NNB, Gastrointestinaltrakt-Blutung (NNB), Gastrointestinaltrakt-Blutung NNB, BLUTUNG GASTRO-INTESTINAL NNB, GASTROINTESTINALE BLUTUNG, Gastrointestinale Blutung, nicht naeher bezeichnet, Gastrointestinale Blutungen, Blutung, gastrointestinale, Gastrointestinalblutung, Magen-Darmblutung
Portuguese Hemorragia gastrointestinal NE, Hemorragia do tubo digestivo, Hemorragia do tubo digestivo NE, Hemorragia gastrintestinal, Hemorragia GI, Hemorragia gastrintestinal NE, Hemorragia Gastrintestinal, HEMORRAGIA DIGESTIVA, HEMORRAGIA GI, Hemorragias gastrointestinais, Hemorragia gastrointestinal, Hemorragia Gastrointestinal
Spanish Hemorragia gastrointestinal NEOM, Hemorragia del tubo digestivo, Sangrado gastrointestinal, Hemorragia GI, Hemorragia del tracto gastrointestinal, no especificada, Sangrado GI, Sangre en tracto GI, Sangrado del tracto gastrointestinal (NEOM), Sangrado del tracto gastrointestinal, Sangrado del tracto gastrointestinal NEOM, HEMORRAGIA GI, HEMORRAGIA TRACTO GI SE, hemorragia gastrointestinal no especificada (trastorno), hemorragia gastrointestinal no especificada, hemorragia del tracto gastrointestinal, SAI (trastorno), Gastrointestinal tract hemorrhage NOS, hemorragia del tracto gastrointestinal, SAI, Gastrointestinal tract haemorrhage NOS, HD, hemorragia digestiva (trastorno), hemorragia digestiva, hemorragia gastrointestinal, sangrado gastrointestinal, Hemorragias gastrointestinales, Hemorragia gastrointestinal, Hemorragia Gastrointestinal
Japanese 胃腸管出血（ＮＯＳ）, 胃腸管出血ＮＯＳ, 胃腸出血ＮＯＳ, 胃腸管出血、詳細不明, 胃腸管出血, ｲﾁｮｳｶﾝｼｭｯｹﾂｼｮｳｻｲﾌﾒｲ, ｲﾁｮｳｼｭｯｹﾂ, ｲﾁｮｳｼｭｯｹﾂNOS, ｲﾁｮｳｶﾝｼｭｯｹﾂNOS, ｲﾁｮｳｶﾝｼｭｯｹﾂ, ｼｮｳｶｶﾝｼｭｯｹﾂ, 出血-胃腸, 出血-消化管, 消化管出血, 胃腸出血
Swedish Blödning i mag-tarmkanal
Czech gastrointestinální hemoragie, Krvácení gastrointestinálního traktu NOS, Krvácení gastrointestinální, Krvácení gastrointestinálního traktu, Gastrointestinální krvácení, Krvácení do gastrointestinálního traktu, Krvácení gastrointestinálního traktu, blíže neurčené, Gastrointestinální krvácení NOS, Krvácení trávicího traktu, Krvácení do trávicího traktu, Krvácení do zažívacího traktu, krvácení do gastrointestinálního traktu, krvácení do zažívacího traktu, gastrointestinální krvácení, krvácení do trávicího traktu
Finnish Ruuansulatuskanavan verenvuoto
Russian ZHELUDOCHNO-KISHECHNOE KROVOTECHENIE, KALOVYE MASSY, KROV', KROVOTECHENIE ZHELUDOCHNO-KISHECHNOE, EKSKREMENTY, KROV', KROVIANISTYI STUL, ЖЕЛУДОЧНО-КИШЕЧНОЕ КРОВОТЕЧЕНИЕ, КАЛОВЫЕ МАССЫ, КРОВЬ, КРОВОТЕЧЕНИЕ ЖЕЛУДОЧНО-КИШЕЧНОЕ, КРОВЯНИСТЫЙ СТУЛ, ЭКСКРЕМЕНТЫ, КРОВЬ
Korean 상세불명의 위창자 출혈
Croatian GASTROINTESTINALNO KRVARENJE
Latvian Not Translated[Gastrointestinal Hemorrhage]
Polish Krwotok żołądkowo-jelitowy
Hungarian Gastrointestinalis rendszer vérzése (k.m.n.), Gastrointestinalis rendszer vérzése k.m.n., Gastrointestinalis traktus vérzése, Gyomor-bélrendszeri traktus vérzése, nem meghatározott, Gastrointestinalis haemorrhagia, Gastrointestinalis vérzések, Gastrointestinalis vérzés, Emésztőrendszer vérzése, Gastrointestinalis traktus vérzése, nem meghatározott, Vér a gyomor-bélrendszerben, Gasztrointesztinalis vérzés, Vérzés gastrointestinalis, Vérzés gyomor-bélrendszeri, Gastrointestinalis rendszer vérzése, Gastrointestinalis vérzés k.m.n., Gastrointestinalis hemorrhágia, Gyomor-bélrendszeri hemorrhágia, Gasztrointesztinalis hemorrhágia, Gyomor-bélrendszeri vérzés, Emésztőrendszeri vérzés, Gasztrointestinális vérzés
Norwegian Blødning, gastrointestinal, Gastrointestinal blødning
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hematochezia (C0018932)

Definition (MSHCZE) Pasáž čerstvé krve per rectum při gastrointestinálním krvácení. (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (NCI) The passage of fresh blood from the anus. The blood is usually seen in the stools. The most common cause is lower gastrointestinal tract hemorrhage.
Definition (MSH) The passage of bright red blood from the rectum. The blood may or may not be mixed with formed stool in the form of blood, blood clots, bloody stool or diarrhea.
Concepts Disease or Syndrome (T047)
MSH D006471
SnomedCT 405729008, 72256005, 236068001
English Hematochezias, Faeces: blood, BRBPR - Bright red blood per rectum, Feces: blood, Blood in faeces, Passage of bloody stools, Blood in feces, BRBPR, bright red blood per rectum (symptom), red blood in bowel movement (symptom), hematochezia, bright red blood per rectum, red blood in stool, red blood in bowel movement (hematochezia), red blood in bowel movement, blood bright red stools, brbpr, bright red blood stool, rectal bleeding bright red, blood in faeces, bloody stools, bright red blood in stool, blood in stool, fresh blood stool, haematochezia, blood fresh stools, fresh blood in stool, blood in feces, bloody stool, Blood in stool, Bloody feces, Fresh blood passed per rectum, Fresh blood passed per rectum (finding), Bloody stool, Haematochezia, Bright red blood in stool, Bright red blood per rectum, Hematochezia (finding), Hematochezia
German Haematochezia, Hämatochezie, Blutstuhl
Portuguese Hematoquesia, Hematoquezia, Hematoquezia / fezes sanguinolentas
Japanese 血便排泄, ｹﾂﾍﾞﾝﾊｲｾﾂ
Spanish deposición con sangre, sangre roja en heces, Hematoquezia, enterorragia, hematoquecia, enterorragia (hallazgo), rectorragia, hematoquezia (hallazgo), hematoquezia, hematoquecia (trastorno), sangre fresca por vía rectal (hallazgo), sangre fresca por vía rectal, Hematoquecia
French Émission de selles sanglantes, Hématochésie, Rectorragie, Hématochézie
Czech Hematochezie, hematochezie
Hungarian Haematochezia
Norwegian Hematochezi
Italian Ematochezia
Dutch bloederige faeces, Hematochezia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Melena (C0025222)

Definition (MSHCZE) Dehtovitě černá stolice obsahující natrávenou krev. Příznak krvácení do horní části trávicí trubice (během další pasáže dochází k natrávení a k chemickým reakcím v důsledku působení střevních bakterií). Příčinou může být peptický vřed či erozivní gastritida (často podmíněná nesteroidními antirevmatiky, vč. aspirinu), nádory, Malloryho-Weissův syndrom, jícnové varixy, koagulopatie aj. Některé stavy mohou současně způsobit hematemezi. Meléna je indikací k endoskopii, silné krvácení může vést k hypovolemii. Černé zbarvení stolice může být způsobeno i složením potravy či některými léky (železo, adsorpční uhlí). (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (NCI) Abnormally dark tarry feces containing blood, usually from gastrointestinal bleeding.
Definition (MSH) The black, tarry, foul-smelling FECES that contain degraded blood.
Concepts Pathologic Function (T046)
MSH D008551
ICD10 K92.1
SnomedCT 197470007, 155839001, 2901004
English Melenas, MELAENA, MELENA, STOOL BLACK, STOOL TARRY, Alt blood passed per rectum, Black faeces, Black faeces symptom, Black feces, Black feces symptom, Melena [Disease/Finding], black faeces, black tarry stools, Stool(s);black, dark stools, tarry stools, black tarry stool, black colored stool, black stool, dark stool, melenas, Stool(s);tarry, black feces, black color stools, black stools, Altered blood in stools, Melaena (disorder), Melaena, Tarry stools, Altered blood in stool, Altered blood passed per rectum, Black, tarry stool, Melena (disorder), melena, Melena, melaena, tarry stool
Portuguese MELENA, FEZES NEGRAS, FEZES SEMELHANTES A ALCATRAO, Melena
German MELAENA, STUHL SCHWARZ, TEERSTUHL, Melaena, Teerstuhl
French Méléna, Mélaena, MELENA, SELLES D'ASPECT GOUDRONNEUX, SELLES NOIRES
Japanese メレナ, ﾒﾚﾅ
Finnish Meleena
Russian MELENA, МЕЛЕНА
Spanish HECES ALQUITRANADAS, HECES NEGRAS, MELENAS, heces alquitranadas, melena (trastorno), melena, Melenas, Melena
Czech Melena, melena, meléna
Korean 흑색변
Swedish Blodfärgad avföring
Croatian MELENA
Latvian Melēna
Polish Stolce krwawe, Stolce smołowate, Wypróżnienia smoliste, Stolce smoliste
Hungarian Melaena
Norwegian Blodig avføring, Melena
Dutch melaena, Melaena
Italian Melena
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Acute gastrointestinal hemorrhage (C0266807)

Concepts Disease or Syndrome (T047)
SnomedCT 27719009
English acute bleeding gi, acute gastrointestinal bleeding, acute gi bleeding, acute gastrointestinal bleed, acute gi haemorrhage, acute gi bleed, acute bleed gi, Acute gastrointestinal hemorrhage, Acute GI bleeding, Acute GI haemorrhage, Acute GI hemorrhage, Acute gastrointestinal bleeding, Acute gastrointestinal haemorrhage, Acute gastrointestinal hemorrhage (disorder)
Spanish hemorragia GI aguda, hemorragia aguda gastrointestinal, hemorragia gastrointestinal aguda (trastorno), hemorragia gastrointestinal aguda, sangrado GI agudo, sangrado gastrointestinal agudo
Sources
Derived from the NIH UMLS (Unified Medical Language System)


maroon stools (C2130275)

Concepts Sign or Symptom (T184)
English maroon stools, maroon stools (symptom)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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