Gastrointestinal haemorrhage

Gastrointestinal haemorrhage

The aetiology of acute gastrointestinal (GI) haemorrhage varies between the upper GIT (common causes including peptic ulcer disease, varices and Mallory–Weiss tears) and the lower GIT (common causes including angiodysplasia, diverticular haemorrhage and neoplastic lesions). While endoscopy is a useful first-line investigation for both, in refrac tory or occult GI haemorrhage radiology can also contribute to diagnosis and management. Nuclear medicine scans using radioisotope-labelled red blood cells are useful when bleeding is intermittent, but for patients suspected of active bleeding the best investigation is a CT mesenteric angiog ram. Non-contrast scans to look for bright blood in the bowel lumen should be supplemented with scans in the arterial phase to assess for a blush due to active extravasation and the portal venous phase to optimise detection of wall thickening and masses and to look for sites of venous bleeding. If non-invasive imaging is e ff ective, catheter angiography can be used to embolise a bleeding point. Gastrointestinal haemorrhage

The aetiology of acute gastrointestinal (GI) haemorrhage varies between the upper GIT (common causes including peptic ulcer disease, varices and Mallory–Weiss tears) and the lower GIT (common causes including angiodysplasia, diverticular haemorrhage and neoplastic lesions). While endoscopy is a useful first-line investigation for both, in refrac tory or occult GI haemorrhage radiology can also contribute to diagnosis and management. Nuclear medicine scans using radioisotope-labelled red blood cells are useful when bleeding is intermittent, but for patients suspected of active bleeding the best investigation is a CT mesenteric angiog ram. Non-contrast scans to look for bright blood in the bowel lumen should be supplemented with scans in the arterial phase to assess for a blush due to active extravasation and the portal venous phase to optimise detection of wall thickening and masses and to look for sites of venous bleeding. If non-invasive imaging is e ff ective, catheter angiography can be used to embolise a bleeding point. Gastrointestinal haemorrhage

The aetiology of acute gastrointestinal (GI) haemorrhage varies between the upper GIT (common causes including peptic ulcer disease, varices and Mallory–Weiss tears) and the lower GIT (common causes including angiodysplasia, diverticular haemorrhage and neoplastic lesions). While endoscopy is a useful first-line investigation for both, in refrac tory or occult GI haemorrhage radiology can also contribute to diagnosis and management. Nuclear medicine scans using radioisotope-labelled red blood cells are useful when bleeding is intermittent, but for patients suspected of active bleeding the best investigation is a CT mesenteric angiog ram. Non-contrast scans to look for bright blood in the bowel lumen should be supplemented with scans in the arterial phase to assess for a blush due to active extravasation and the portal venous phase to optimise detection of wall thickening and masses and to look for sites of venous bleeding. If non-invasive imaging is e ff ective, catheter angiography can be used to embolise a bleeding point.