Introduction.
Clinical notes Fig. 2
AGIB is a common medical emergency with annual incidence of:
•Upper GI bleeding: 40-150 episodes/100.000 persons
•Lower GI bleeding: 20-27 episodes/100.000 persons.
The anatomical landmark to delimit high and low bleeding is the ligament of Treitz,
but in clinical setting things are often not as clear,
and rectal bleeding can be the first sign of an upper GI hemorrhage.
The clinical presentation varies depending on the location of the source of bleeding and the volume of blood loss.
Even without hematemesis,
almost half of patients in the Emergency Department will have an upper GI source.
Overall mortality ranges from 4% to 16% but can reach 40% when bleeding is severe,
mainly in elderly patients with comorbidities.
GI bleeding is intermittent in nature
•75% will stop spontaneously
•25% will recur
Introduction
Clinical objectives and diagnostic toolsFig. 3
Rapid identification of the source and cause of bleeding are primary objectives in the evaluation of GI hemorrhage to guide proper therapy.
Colonoscopy has been the technique of choice for ALIB,
but in emergency setting poses a variety of challenges related to:
•Availability 24/7
•Time spent on bowel cleansing vs.
poor visualization owing to feces or intraluminal clots
•Bleeding source located in the small bowel.
Conventional angiography and emergency surgery are invasive and expensive procedures,
usually reserved for therapy.
CT angiography is feasible in emergency and correctly depicts the presence and location of active or recent hemorrhage,
as well as the potential cause,
in the majority of patients.