Gastroenterology Book

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Small Intestinal BleedingAka: Small Bowel Bleeding, Obscure Bleeding

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  1. See also
    1. Gastrointestinal Bleeding
    2. Occult Gastrointestinal Bleeding
    3. Occult Gastrointestinal Bleeding Causes
  2. Epidemiology
    1. May represent 5-10% of GI Bleeding sources
  3. Causes
    1. See Occult Gastrointestinal Bleeding Causes
    2. Angiodysplasia (most common cause)
      1. Associated conditions
        1. Chronic Renal Failure
        2. Aortic Stenosis
        3. Cirrhosis
        4. Von Willebrand's Disease
    3. Neoplasms (usually cause chronic intermittent bleeding)
    4. Ulcers
    5. Crohn's Disease
    6. Diverticula
    7. Meckel's Diverticulum
  4. Diagnosis
    1. Best tests to identify bleeding source
      1. Video Capsule Endoscopy
        1. Costamagna (2002) Gastroenterology 123:999
      2. Mesenteric angiography (celiac and mesenterics)
        1. Helpful in brisk Gastrointestinal Bleeding
      3. Endoscopy
        1. Push enteroscopy (longer upper endoscope)
        2. Sonde enteroscopy (small caliber tube via nose)
        3. Intraoperative enteroscopy (during laparotomy)
    2. Low yield tests in identifying bleeding site
      1. Small bowel follow through with enteroclysis
        1. Does not identify mucosal lesions
      2. Double-contrast Barium Enema
        1. Indicated only in suboptimal Colonoscopy
      3. Tagged Red Blood Cell Scan
        1. Requires brisk bleeding (high false negative rate)
        2. May inaccurately localize lesion
  5. References
    1. Fallah (2000) Med Clin North Am 84(5):1183
    2. Leighton (2003) Gastrointest Endosc 58(5):650

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