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Upper and Lower Gastrointestinal Bleeding

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Geriatric Gastroenterology

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Abstract

Old age is associated with increasing incidence, morbidity, and mortality from gastrointestinal bleeding. Upper gastrointestinal bleeding presents with hematemesis, melena, or large amount of blood on nasogastric tube lavage and results mainly from peptic ulcers, gastric or esophageal varices, and esophagitis. Diverticulosis, hemorrhoids, colon cancer, polyps, and angioectasias are the main causes of lower gastrointestinal bleeding, which generally manifests as hematochezia. Initial evaluation of the patient with acute gastrointestinal bleeding should include history taking, physical examination with attention to signs of hypovolemia, performance of nasogastric tube lavage, and rectal examination. The history and physical can narrow the differential diagnosis, which can be confirmed and treated by endoscopy. On presentation, blood should be sent for a complete blood count, typing and crossmatching, basic chemistry, liver function tests, and coagulation studies. Resuscitative measures ought to be immediately undertaken during the patient’s assessment in the emergency department.

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Authors and Affiliations

  1. Robert Wood Johnson School of Medicine, Drexel University School of Medicine, Philadelphia, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Clinical Professor of Medicine)

  2. New York Medical College, Vallhala, NY, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Adjunct Professor of Medicine)

  3. Gastroenterology, Hepatology and Nutrition, Saint Peter’s University Hospital, New Brunswick, NJ, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Chief)

  4. Department of Medicine, Division of Gastroenterology, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA

    Alexander Brun MD

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Correspondence to C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF .

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    C. S. Pitchumoni

  2. (North Division), Department of Medicine, Montefiore Medical Center, 600 East 233rd Street, Bronx, 10466, New York, USA

    T. S. Dharmarajan

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Pitchumoni, C.S., Pitchumoni, C.S., Pitchumoni, C.S., Brun, A. (2012). Upper and Lower Gastrointestinal Bleeding. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1623-5_36

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