Haemorrhage lower gastrointestinal

Treatment of haemorrhagic complications in acute or chronic liver disease initially focuses on the site of bleeding, i.e. in the upper or lower gastrointestinal tract. Mechanical, thermal and sclerotic measures are of prime importance. 

Lower gastrointestinal haemorrhage shows a frequency of 10-15% some 3-5% develop in the small bowel. Intestinal bleeding as a result of liver disease is rare. The initial problem consists in the fact that (7.) numerous and different causes of bleeding must be clarified by differential diagnosis and (2.) severe blood loss together with a concurrent liver disease is always particularly hazardous. 

In lower gastrointestinal haemorrhage, the bleeding site is distal to the duodenojejunal ligament (Treitz s ligament) or the duodenojejunal recessus (i.e. the passage of the duodenum retroperitoneally and its transition to the intraperitoneal jejunum). 

All these diagnostic measures, when implemented specifically and step-by-step, yield a reliability of over 90% in lower gastrointestinal haemorrhage. 

Das, A., et al. (2003). Prediction of outcome in acute lower-gastrointestinal haemorrhage based on an artificial neural network Internal and external validation of apredictive model. Lancet, 362 1261-1266. 

Waugh J,Madan A, SachariasN, Thomson K (2004) Embolization for major lower gastrointestinal haemorrhage five-year experience. Australas Radiol 48 311-317... 

Gastrointestinal A 32-year-old Chinese woman developed acute lower gastrointestinal bleeding after 48h of oral oseltamivir 75 mg twice daily for treatment for HlNlinfluenza A positive infection. Colonoscopy confirmed haemorrhagic colitis. Symptoms resolved after discontinuation of oseltamivir [349 ]. 

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