Alt Gis Kanamalar
Synopsis
Bu bölüm, alt gastrointestinal (GI) kanamaların tanımını, prevelansını, nedenlerini, tanı yöntemlerini ve tedavi yaklaşımlarını ele almaktadır. Alt GI kanamaları, dünya çapında önemli bir sağlık sorunudur ve üst GI kanamalardan daha nadir görülür. Yaşla birlikte sıklığı artar ve yaşlılarda üst GI kanamalardan daha sık görülebilir. Alt GI kanamalarının ana nedenleri arasında divertikülozis, anjiodisplazi, iskemik kolit ve hemoroidler bulunmaktadır. Tanı genellikle muayenede hematokezya ile konur ve detaylı anamnez, fizik muayene ve laboratuvar testleri gerektirir. Görüntüleme yöntemleri arasında anjiografi, sintigrafi ve kolonoskopi bulunmaktadır. Tedavi hastanın hemodinamik durumuna bağlı değişmekle birlikte stabil olmayan hastalarda acil resüsitasyon ve kan transfüzyonu gerekebilir. Anjiografi ve kolonoskopi gibi girişimsel müdahaleler kanamanın kaynağını belirlemede ve tedavide önemli rol oynar. Alt GI kanamalara yaklaşımda gastroenteroloji konsültasyonu sıkça gerekmektedir yoğun bakım takibi gerektiren vakalar açısından dikkatli olunmalıdır. Ayaktan tedavi için Oakland Skorlama Sistemi kullanılmaktadır.
References
ZUCCARO JR, Gregory. Management of the adult patient with acute lower gastrointestinal bleeding. Official journal of the American College of Gastroenterology| ACG, 1998, 93.8: 1202-1208.
DREZDZON, Melissa K.; PETERSON, Kent J. Evaluation and management of lower GI bleeding. Diseases of the Colon & Rectum, 2022, 65.6: 785-788.
WILCOX, C. Mel; ALEXANDER, Lorraine N.; COTSONIS, George. A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia. American Journal of Gastroenterology (Springer Nature), 1997, 92.2.
STRATE, Lisa L. Lower GI bleeding: epidemiology and diagnosis. Gastroenterology Clinics, 2005, 34.4: 643-664.
FARRELL, J. J.; FRIEDMAN, L. S. the management of lower gastrointestinal bleeding. Alimentary pharmacology & therapeutics, 2005, 21.11: 1281-1298.
PEERY, Anne F., et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology, 2012, 142.2: 266-272. e1.
MEYERS, Morton A., et al. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology, 1976, 71.4: 577-583.
HORNER, John L. Natural history of diverticulosis of the colon. The American Journal of Digestive Diseases, 1958, 3: 343-350.
PARKS, T. G. Post-mortem studies on the colon with special reference to diverticular disease. 1968.
GOSTOUT, Christopher J., et al. Acute gastrointestinal bleeding experience of a specialized management team. Journal of clinical gastroenterology, 1992, 14.3: 260-267.
CASARELLA, William J.; KANTER, Ira E.; SEAMAN, William B. Right-sided colonic diverticula as a cause of acute rectal hemorrhage. New England Journal of Medicine, 1972, 286.9: 450-453.
STRATE, Lisa L., et al. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology, 2011, 140.5: 1427-1433.
JANSEN, Antje, et al. Risk factors for colonic diverticular bleeding: a Westernized community based hospital study. World journal of gastroenterology: WJG, 2009, 15.4: 457.
SUZUKI, Kaori, et al. Risk factors for colonic diverticular hemorrhage: Japanese multicenter study. Digestion, 2012, 85.4: 261-265.
FOUTCH, P. Gregory; REX, Douglas K.; LIEBERMAN, David A. Prevalence and Natural History of Colonic Angiodysplasia among Healthy Asymptomatic People∗. American Journal of Gastroenterology (Springer Nature), 1995, 90.4.
BOLEY, Scott J., et al. On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology, 1977, 72.4: 650-660.
DIGGS, Naomi G., et al. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clinical gastroenterology and hepatology, 2011, 9.5: 415-420.
CHAVALITDHAMRONG, Disaya, et al. Ischemic colitis as a cause of severe hematochezia: risk factors and outcomes compared with other colon diagnoses. Gastrointestinal endoscopy, 2011, 74.4: 852-857.
OZDIL, Burhan, et al. Massive lower gastrointestinal hemorrhage secondary to rectal hemorrhoids in elderly patients receiving anticoagulant therapy: case series. Digestive diseases and sciences, 2010, 55: 2693-2694.
RICHARDS, Robert J.; DONICA, Mary Beth; GRAYER, David. Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding?. Journal of clinical gastroenterology, 1990, 12.5: 500-504.
VERNAVA, Anthony M., et al. Lower gastrointestinal bleeding. Diseases of the colon & rectum, 1997, 40: 846-858.
RICHTER, James M., et al. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointestinal endoscopy, 1995, 41.2: 93-98.
NG, Daniel A., et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Diseases of the colon & rectum, 1997, 40.4: 471-477.
HOWARTH, Douglas M. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. In: Seminars in nuclear medicine. WB Saunders, 2006. p. 133-146.
MARTÍ, Milagros, et al. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology, 2012, 262.1: 109-116.
JENSEN, Dennis M.; MACHICADO, Gustavo A. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology, 1988, 95.6: 1569-1574.
ZUCKERMAN, Gary R.; PRAKASH, Chandra. Acute lower intestinal bleedingPart II: Etiology, therapy, and outcomes. Gastrointestinal endoscopy, 1999, 49.2: 228-238.
TROWERS, Eugene A., et al. Endoscopic hemorrhoidal ligation: preliminary clinical experience. Gastrointestinal endoscopy, 1998, 48.1: 49-52.
JENSEN, Dennis M., et al. Prospective randomized comparative study of bipolar electrocoagulation versus heater probe for treatment of chronically bleeding internal hemorrhoids. Gastrointestinal endoscopy, 1997, 46.5: 435-443.
SENGUPTA, Neil, et al. Management of patients with acute lower gastrointestinal bleeding: an updated ACG guideline. Official journal of the American College of Gastroenterology| ACG, 2023, 118.2: 208-231.
TRIANTAFYLLOU, Konstantinos, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2021, 53.08: 850-868.
SARODE, Ravi, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation, 2013, 128.11: 1234-1243.
VILLANUEVA, Càndid, et al. Transfusion strategies for acute upper gastrointestinal bleeding. New England Journal of Medicine, 2013, 368.1: 11-21.
BYERS, Stacie E., et al. Incidence of occult upper gastrointestinal bleeding in patients presenting to the ED with hematochezia. The American journal of emergency medicine, 2007, 25.3: 340-344.
WILCOX, C. Mel; ALEXANDER, Lorraine N.; COTSONIS, George. A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia. American Journal of Gastroenterology (Springer Nature), 1997, 92.2.
PALAMIDESSI, Nicholas, et al. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Academic Emergency Medicine, 2010, 17.2: 126-132.
OAKLAND, Kathryn, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. The Lancet Gastroenterology & Hepatology, 2017, 2.9: 635-643.
DREZDZON, Melissa K.; PETERSON, Kent J. Evaluation and management of lower GI bleeding. Diseases of the Colon & Rectum, 2022, 65.6: 785-788.
WILCOX, C. Mel; ALEXANDER, Lorraine N.; COTSONIS, George. A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia. American Journal of Gastroenterology (Springer Nature), 1997, 92.2.
STRATE, Lisa L. Lower GI bleeding: epidemiology and diagnosis. Gastroenterology Clinics, 2005, 34.4: 643-664.
FARRELL, J. J.; FRIEDMAN, L. S. the management of lower gastrointestinal bleeding. Alimentary pharmacology & therapeutics, 2005, 21.11: 1281-1298.
PEERY, Anne F., et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology, 2012, 142.2: 266-272. e1.
MEYERS, Morton A., et al. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology, 1976, 71.4: 577-583.
HORNER, John L. Natural history of diverticulosis of the colon. The American Journal of Digestive Diseases, 1958, 3: 343-350.
PARKS, T. G. Post-mortem studies on the colon with special reference to diverticular disease. 1968.
GOSTOUT, Christopher J., et al. Acute gastrointestinal bleeding experience of a specialized management team. Journal of clinical gastroenterology, 1992, 14.3: 260-267.
CASARELLA, William J.; KANTER, Ira E.; SEAMAN, William B. Right-sided colonic diverticula as a cause of acute rectal hemorrhage. New England Journal of Medicine, 1972, 286.9: 450-453.
STRATE, Lisa L., et al. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology, 2011, 140.5: 1427-1433.
JANSEN, Antje, et al. Risk factors for colonic diverticular bleeding: a Westernized community based hospital study. World journal of gastroenterology: WJG, 2009, 15.4: 457.
SUZUKI, Kaori, et al. Risk factors for colonic diverticular hemorrhage: Japanese multicenter study. Digestion, 2012, 85.4: 261-265.
FOUTCH, P. Gregory; REX, Douglas K.; LIEBERMAN, David A. Prevalence and Natural History of Colonic Angiodysplasia among Healthy Asymptomatic People∗. American Journal of Gastroenterology (Springer Nature), 1995, 90.4.
BOLEY, Scott J., et al. On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology, 1977, 72.4: 650-660.
DIGGS, Naomi G., et al. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clinical gastroenterology and hepatology, 2011, 9.5: 415-420.
CHAVALITDHAMRONG, Disaya, et al. Ischemic colitis as a cause of severe hematochezia: risk factors and outcomes compared with other colon diagnoses. Gastrointestinal endoscopy, 2011, 74.4: 852-857.
OZDIL, Burhan, et al. Massive lower gastrointestinal hemorrhage secondary to rectal hemorrhoids in elderly patients receiving anticoagulant therapy: case series. Digestive diseases and sciences, 2010, 55: 2693-2694.
RICHARDS, Robert J.; DONICA, Mary Beth; GRAYER, David. Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding?. Journal of clinical gastroenterology, 1990, 12.5: 500-504.
VERNAVA, Anthony M., et al. Lower gastrointestinal bleeding. Diseases of the colon & rectum, 1997, 40: 846-858.
RICHTER, James M., et al. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointestinal endoscopy, 1995, 41.2: 93-98.
NG, Daniel A., et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Diseases of the colon & rectum, 1997, 40.4: 471-477.
HOWARTH, Douglas M. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. In: Seminars in nuclear medicine. WB Saunders, 2006. p. 133-146.
MARTÍ, Milagros, et al. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology, 2012, 262.1: 109-116.
JENSEN, Dennis M.; MACHICADO, Gustavo A. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology, 1988, 95.6: 1569-1574.
ZUCKERMAN, Gary R.; PRAKASH, Chandra. Acute lower intestinal bleedingPart II: Etiology, therapy, and outcomes. Gastrointestinal endoscopy, 1999, 49.2: 228-238.
TROWERS, Eugene A., et al. Endoscopic hemorrhoidal ligation: preliminary clinical experience. Gastrointestinal endoscopy, 1998, 48.1: 49-52.
JENSEN, Dennis M., et al. Prospective randomized comparative study of bipolar electrocoagulation versus heater probe for treatment of chronically bleeding internal hemorrhoids. Gastrointestinal endoscopy, 1997, 46.5: 435-443.
SENGUPTA, Neil, et al. Management of patients with acute lower gastrointestinal bleeding: an updated ACG guideline. Official journal of the American College of Gastroenterology| ACG, 2023, 118.2: 208-231.
TRIANTAFYLLOU, Konstantinos, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2021, 53.08: 850-868.
SARODE, Ravi, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation, 2013, 128.11: 1234-1243.
VILLANUEVA, Càndid, et al. Transfusion strategies for acute upper gastrointestinal bleeding. New England Journal of Medicine, 2013, 368.1: 11-21.
BYERS, Stacie E., et al. Incidence of occult upper gastrointestinal bleeding in patients presenting to the ED with hematochezia. The American journal of emergency medicine, 2007, 25.3: 340-344.
WILCOX, C. Mel; ALEXANDER, Lorraine N.; COTSONIS, George. A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia. American Journal of Gastroenterology (Springer Nature), 1997, 92.2.
PALAMIDESSI, Nicholas, et al. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Academic Emergency Medicine, 2010, 17.2: 126-132.
OAKLAND, Kathryn, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. The Lancet Gastroenterology & Hepatology, 2017, 2.9: 635-643.
Volume
Pages
139-146
Published
May 3, 2024
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1.
Çakmak O. Alt Gis Kanamalar. In: Akman C, Karcıoğlu Ö, editors. Dahili Aciller [Internet]. Türkiye: Academician Publishing Book DOI Portal; 2024 [cited 2026 Jul. 13]. pp. 139-46. Available from: https://omp35.books.akademisyen.net/index.php/akya/catalog/book/3074/chapter/13166
