[Gastrointestinal hemorrhage: how much evaluation is necessary?].
For this study data from a total of 362 patients covering a time period of 10 years (1979-1989) were analyzed. Referal to the medical outpatient clinic of Zurich occurred in over 90% of the cases for evaluation of incidental iron deficiency anemia or suspected of gastrointestinal bleeding because of melanea/hematemesis. The evaluation comprised endoscopy, in part radiography of the upper intestinal tract and rarely angiography and scintigraphic tracer studies. 95 patients (26%) had benign lesions in the gastro-intestinal tract, 88 patients (26%) had endoscopy without abnormal findings. Iron deficiency was thought to be due to hypermenorrhea in 45 patients (13%) and to other non-gastrointestinal causes in 43 patients (13%) by exclusion. A malignancy of the gastrointestinal tract was found in 25 patients (7%): 18 carcinomas of the colon, 6 carcinomas of the stomach and 1 metastasis of a melanoma to the coecum. In 80% of the patients with malignancies occult fecal blood was detected. In 154 patients (42%) extensive diagnostic investigation including sometimes even repeated endoscopy could not disclose the cause of blood loss. 88 (24%) of these patients had slight iron deficiencies (hemoglobin > 10 g/dl, hemoccult-test positive in 65% of cases), 66 (18%) had severe iron-deficiencies (hemoglobin < 10 g/dl, hemoccult-test positive in 90% of cases). Selective small bowel radiography was performed in 36 patients without any positive findings. Patients with gastro-intestinal bleeding of undetermined etiology present a diagnostic challenge for the general practitioner.(ABSTRACT TRUNCATED AT 250 WORDS)
Oberle
E
E
Medizinische Abteilung, Kantonsspital Glarus.
Brunner
K
K
Rhyner
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000175:diagnosis; D006396:Hematemesis / Q000209:etiology; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D009780:Occult Blood
Gastrointestinale Blutung: Wieviel Abklärung braucht es?