Gastritis and Gastrointestinal Bleeding

Published on 06/06/2015 by admin

Filed under Pediatrics

Last modified 06/06/2015

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108 Gastritis and Gastrointestinal Bleeding

Numerous potential etiologies, combined with the gastrointestinal (GI) tract’s extensive surface area, can make the assessment and management of GI bleeding exceptionally challenging. Observations of several key clinical features assist clinicians in formulating rational differential diagnoses. Gastritis is an important cause of GI bleeding and abdominal pain that deserves particular attention. Although the inability to arrive at a definitive diagnosis (i.e., obscure GI bleeding) remains a significant problem, the growing arsenal of diagnostic modalities is making it increasingly possible to isolate the source of bleeding and construct a successful treatment strategy.

Etiology and Pathogenesis

The causes of GI bleeding are diverse (Figure 108-1). Although the sheer number of causes may seem intimidating, grouping them into pathophysiologic categories aids in constructing a differential diagnosis. Note that underlying disorders of coagulation (e.g., hemophilias, vitamin K deficiency in neonates) and hepatic dysfunction (caused by the liver’s role in producing coagulation factors) can exacerbate any of these causes.

Mucosal Erosion

The GI tract has a robust and sophisticated mucosal defense mechanism designed to prevent erosion. These protective elements include (1) the superficial “unmixed” layer of mucus, bicarbonate, and other factors that form a neutralizing barrier against acid, enzymatic, and abrasive injury; (2) the epithelial cells that generate this superficial layer; (3) continuous cell renewal coupled with (4) uninterrupted nutrient blood flow to the mucosa and (5) sensory innervation that optimizes this blood flow; and (6) endothelial production of prostaglandins and nitric oxide, which synergize to promote all of the aforementioned mechanisms. Disruption of any of these factors may predispose a given region of mucosa to erosion, local loss of vascular integrity, and resultant bleeding.

Vascular Abnormalities

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