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lower-gi-bleed-risk-factors

Lower GI Bleeds: Risk factors Portal Esophageal varices (large veins in the esophagus that are at risk for bleeding) Rectal varices (large veins in the rectum that are at risk for bleeding) Splenomegaly (enlargement of the spleen) Large spleen sequesters (traps) platelets, reducing blood platelet counts ↓ Clotting ability of the blood ↓ Epithelial protection along entire GI tract Pre-existing damage to the lower GI tract epithelium Malignant tissue invades the colon wall and disrupts colonic blood vessels New, extremely friable blood vessels develop within the tumor Venous blood pressure exceeds vessel wall strength, and the vessel ruptures and bleeds Blood moves rapidly through the GI tract (this is an upper GI bleed that can produce lower GI bleed symptoms) Hematochezia (bright red blood per rectum) Damaged liver tissue restricts blood flow through liver hypertension (high blood pressure in the veins running from the GI tract to the liver) Blood backs up in the splenic vein Venous blood pressure exceeds vessel wall strength, and the vessel ruptures and bleeds Liver cirrhosis Authors: Yan Yu, Miranda Schmidt Illustrator: Mizuki Lopez Reviewers: Michael Blomfield, Tony Gu, Jason Baserman, Jennifer Au, Vina Fan, Ben Campbell, Kerri Novak* * MD at initial time of publication ↓ Synthesis of blood clotting factors that are normally produced in the liver (i.e. fibrinogen) Bleeding of capillaries under the skin Petechiae (small red dots on skin) Inferior Vena Cava Blood clotting defect (genetic disorder, Acetylsalicylic Acid use) Non-Steroidal Anti- Inflammatory Drug (NSAID) Use Prior lower GI bleeds Family history of colorectal cancer Diaphragm Esophagus ↓ Systemic prostaglandin synthesis ↑ Risk for lower GI bleed ↑ Risk for colorectal cancer Development of colorectal cancer Duodenum Ligament of Treitz Lower GI Bleeds are intra-luminal GI tract bleeds that occur anywhere distal to the ligament of Treitz (transition between duodenum and jejunum) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-Published June 30, 2019, updated August 15, 2022 on www.thecalgaryguide.com