anemia secondary gi bleeding

8/11/2019 Anemia Secondary GI Bleeding

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Anemia secondary GI Bleeding

CAPTER I

CASE

KEY WORDS

Woman 65 years old

Complaining of worsening shortness of breath

Feeling dizzy

Dypsneu walking up

Review of system is significant for knee pain

Take ibuprofen or aspirin

Alcoholic drink and denies tobacco or drug

Blood pressure is 150/85 mmHg

Pulse is 98 beats/min(increase)

Saturation is 99%

Conjunctivac pallor

Epigastric and left upper quadrant (LUQ) region of the abdomen with

normal bowel sounds

No organo megaly but a positif stool guaic test

CAPTER II

Theory

1.Anemia

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal.

Cause anemia:

1. Blood loss:excessive bleeding such as hemorrhages or abnormal menstrual bleeding2. Chronic illnesssecondary to refractory anemia: inflammatory GI/GU diseases, malignancies

(cancer), arthritis, kidney or liver failure, and acute and chronic infections3. Cancer therapy:surgery, radiotherapy, chemotherapy and/or immunotherapy4. Infiltration(replacement) of bone marrow with cancer5. Hemolysis:Breakdown or destruction of red blood cells6. Decreased red cell productiondue to low levels of erythropoietin (a hormone produced by the

kidney {90%} and liver {10%}) which promotes red blood cell production


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Type of Anemia Description Examples of Causes

IronDeficiency Lack of iron leads to decreased amounts

hemoglobin; low levels of hemoglobin in turn

leads to decreased production of normal

RBCs

Blood loss; diet low in iron; poor

absorption of iron

Pernicious Anemia and

B Vitamin Deficiency

Lack of B vitamins does not allow RBCs to

grow and then divide as they normally would

during development; leads to decreased

production of normal RBCs

Lack of intrinsic factor; diet low in B

vitamins; decreased absorption of B

vitamins

Aplastic Decreased production of all cells produced

by the bone marrow of which RBCs are one

type

Cancer therapy, exposure to toxins,

autoimmune disorders, viral infections

Hemolytic RBCs survive less than the normal 120 days

in the circulation; leads to overall decreased

numbers of RBCs

Inherited causes include sickle cell and

thalassemia; other causes include

transfusion reaction, autoimmune

disease, certain drugs (penicillin)

Anemia of Chronic

Diseases/secondary

Various conditions over the long term can

cause decreased production of RBCs

Kidney disease, diabetes, tuberculosis or

HIV,gastritis

Signs and Symptoms

Though different types of anemias have different causes, the signs and symptoms can be very similar. Mild or

moderate forms of anemia may cause few, if any, symptoms. The most common symptoms are:

a general feeling of tiredness or weakness (fatigue)

lack of energy

Other signs and symptoms that may develop as the anemia becomes more severe include headache, dizziness,

feeling of cold or numbness in hands and/or feet, pale complexion, shortness of breath, fast or irregular heartbeat,

and chest pain.

Laboratory Tests

Complete Blood Count (CBC)

Anemia may first be detected when a Complete Blood Count (CBC) is done during a health exam or as part of testing

for other conditions. A CBC is often ordered as part of a yearly physical exam. It is a routine test that counts the

number and relative proportion of each of the different types of cells in your blood stream. It gives your doctor

information about the size, shape, and relative maturity of the blood cells present in your blood at that moment.


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treatment

First make a diagnosis.The successful treatment of anemias depends on identifying and treating the underlying cause: bloodloss, a nutritional deficiency, cancer, bone marrow infiltration, chronic illness, inflammation, or decreasedresponse to erythropoietin. Through laboratory test results and a physical examination, a physician candetermine the cause of your anemia and identify the best approach to treating it

This may include:

1. Nutritional supplements - Iron, B12 or folic acid2. Treatment of infections, inflammations or malignancies3. Erythropoietin4. Blood transfusions Providing red blood cell transfusions for bleeding and/or severe chronic anemiasmay be lifesaving. Red cell transfusions are the old mainstay, which offers the quickest relief for anemias.However, there are risksassociated with transfusions.

A. Allergic reactionsB. Transmissions of infectious agents (hepatitis, HIV, and Human Leukemia Virus (HTLV)C. HBV (hepatitis B virus): 1 in 63,000

D. HIV (AIDS) risk: 1 in 675,000 (5,000-1,000,000)E. HIV 2:


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Pernicious anemia:Permicious anemia can result in atrophic gastritis. People with pernicious anemia

may have gastric polyps and get gastric cancer and gastric carcinoid tumors twice as often than the

normal population.

Autoimmune Gastritis:The immune system makes antibodies and other proteins that fight off infection

and keep the body healthy. In some disorders, the body mistakenly targets one of its own organs as a

foreign protein or infection. It makes antibodies against it and can severely damage or even destroy the

organ. The stomach lining also may be attacked by the immune system leading to loss of the stomach

cells. This causes acute and chronic inflammation which can result in a condition called pernicious

anemia. The anemia occurs because the body no longer can absorb vitamin B12 due to a lack of a key

stomach factor, destroyed by the chronic inflammation. A form of anemia that occurs when the stomach

lacks a naturally occurring substance needed to properly absorb and digest vitamin B12. A lack of vitamin

B12 may change the surface of the tongue and shrink or thin the stomach lining.

Regular use of pain relievers:Non-steroidal anti-inflammatory drugs (NSAIDs) reduce prostaglandin

which preserves the stomach mucosa thereby cause inflammation of stomach lining.

Stress:Severe stress due to major surgery, traumatic injury, burns or severe infections can cause

gastritis as well as ulcers and stomach bleeding.

Alcohol addiction:It can irritate and erode the gastric mucosa.

Cocaine:Cocaine damages the stomach lining and may lead to hemorrhage.

Radiation and chemotherapy:Chemotherapy and radiation given for cancer can cause irreversible

erosions of the stomach lining and destruction of acid-producing glands.

Other factors:Gastritis may be associated with other medical conditions, including HIV/AIDS, parasitic

infections, some connective tissue disorders, and liver or kidney failure.

The signs and symptoms of gastritis include:

A gnawing or burning ache or pain in the upper abdomen that may become either worse or better

after eating.

Loss of appetite.

Bloating: A feeling of fullness in upper abdomen after eating Weight loss.

Belching: Belching either does not relieve the pain or relieves it only briefly.

Nausea and vomiting: The vomit may be clear, green or yellow, blood-streaked, or completely

bloody, depending on the severity of the stomach inflammation.

In more severe gastritis, bleeding may occur inside the stomach. Any of the following symptoms can be

seen as well as those already mentioned.


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Pallor, sweating, and rapid (or "racing") heart beat.

Feeling faint or short of breath

Chest pain or severe stomach pain

Vomiting large amounts of blood

Bloody bowel movements or dark, sticky, very foul-smelling bowel movements

Treatment depends upon the cause of gastritis. It may include lifestyle changes, medication or rarely

surgery. Medication includes, Antacids, H2 blockers, Proton pump inhibitor, Antibiotics, antidiarrheal

agents etc. In some patients the side effects of these drugs may seen:

Antacids:Antacids containing Aluminum and Magnesium are given but contraindicated in

documented hypersensitivity, it cant be safely used in pregnancy as it decreases effect of

allopurinol, amprenavir, chloroquine, corticosteroids, diflunisal, digoxin, ethambutol, iron salt, H2

antagonists, isoniazid, penicillamine, phenothiazines, tetracycline, thyroid hormones & ticlopidine;

increases effect of benzodiazepines & amphetamine; may cause Aluminum toxicity with ascorbic

acid. Magnesium containing antacids may cause diarrhea and may lead to dehydration.

Patient having history of gastrointestinal bleeding can not take Aluminum and Magnesium

containing antacids.

H2 Blockers:Cimetidine [Tagmet] is commonly given to the patient, it may lead to confusional

states; may cause impotence and gynaecomastia in young males.

Proton Pump Inhibiters: Omeperozol [Prilosec] drug given to patients may increase toxicity of

warfarin, digoxin and phenytoin.

Antibiotics:Amoxicillin is contraindicated in hepatic dysfunction. It reduces efficacy of oral

contraceptives. Tetracycline used during teeth development can cause permanent discoloration

of teeth.

Antidiarrheal Agents: They are used along with antibiotics and proton pump inhibitors/H2

Receptor Antagonists to eradicate H.Pylori. Administration along with anticoagulants may

increase risk of bleeding. It may cause darkening of tongue and black stool which is temporary.

CHAPTER III

Analysis Anemia Gastrointestinal Bleeding

Permicious anemia can result in atrophic gastritis. People with pernicious anemia may have gastric

polyps and get gastric cancer and gastric carcinoid tumor.

Etiologi.

Inanition .This may be due to insufficient food, or the quantity may be sufficient, but lack the constituents

necessary for the elaboration of a normal blood supply, or, having a sufficient quantity and quality of food,

there may be wrongs of the digestive apparatus whereby digestion and assimilation are impaired, thus

result in a failure to manufacture good material into blood.

Symptoms .


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Pallor of the skin, colorless appearance of the ears, and particularly of the mucous membrane.

CHAPTER IV

Discussion

anemia secondary gi bleeding

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