Etiology: Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own

tissues
and organs. Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys,
blood cells, heart and lungs. Lupus occurs more frequently in women, though it isn't clear why. Four types of lupus exist
— systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus and neonatal lupus. Of
these, systemic lupus erythematosus is the most common and serious form of lupus. The outlook for people with lupus
was once grim, but diagnosis and treatment of lupus has improved considerably. With treatment, most people with lupus
can lead active lives.

Symptoms: Fatigue, fever, weight loss, joint pain, stiffness, swelling, butterfly shaped rash, skin lesions, mouth sores, hair
loss, shortness of breath, chest pain, dry eyes, easy bruising, anxiety, depression, and memory loss.

Causes: Lupus is an autoimmune disease, which means that instead of just attacking foreign substances, such as bacteria
and viruses, your immune system also turns against healthy tissue. This leads to inflammation and damage to various
parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels and brain. Doctors don't know what causes
autoimmune diseases, such as lupus. It's likely that lupus results from a combination of your genetics and your
environment. Doctors believe that you may inherit a predisposition to lupus, but not lupus itself. Instead, people with an
inherited predisposition for lupus may only develop the disease when they come into contact with something in the
environment that can trigger lupus, such as a medication or a virus.

Risk Factors: Between the ages of 15 and 40, blacks, Hispanics and Asians, more common in women, exposure to
sunlight, infection with Epstein-Barr, use of hydralazine, and other HTN medications.
Etiology: There are many possible causes (see Table 1: GI Bleeding: Common Causes of GI Bleeding ), which are divided
into upper GI (above the ligament of Treitz), lower GI, and small bowel. Bleeding of any cause is more likely, and
potentially more severe, in patients with chronic liver disease (eg, from alcohol abuse or chronic hepatitis), in those with
hereditary coagulation disorders, or in those taking certain drugs. Drugs associated with GI bleeding include
anticoagulants

Evaluation: Stabilization with airway management, IV fluids, or transfusions is essential before and during diagnostic
evaluation. History: History of present illness should attempt to ascertain quantity and frequency of blood passage.
However, quantity can be difficult to assess because even small amounts (5 to 10 mL) of blood turn water in a toilet bowl
an opaque red, and modest amounts of vomited blood appear huge to an anxious patient. However, most can distinguish
among blood streaks, a few teaspoons, and clots. Those with hematemesis should be asked whether blood was passed
with initial vomiting or only after an initial (or several) nonbloody emesis. Those with rectal bleeding should be asked
whether pure blood was passed; whether it was mixed with stool, pus, or mucus; or whether blood simply coated the
stool. Those with bloody diarrhea should be asked about travel or other possible exposure to GI pathogens. Review of
symptoms should include presence of abdominal discomfort, weight loss, easy bleeding or bruising, previous colonoscopy
results, and symptoms of anemia (eg, weakness, easy fatigability, dizziness). Past medical history should inquire about
previous GI bleeding (diagnosed or undiagnosed); known inflammatory bowel disease, bleeding diatheses, and liver
disease; and use of any drugs that increase the likelihood of bleeding or chronic liver disease (eg, alcohol). Physical
examination: General examination focuses on vital signs and other indicators of shock or hypovolemia (eg, tachycardia,
tachypnea, pallor, diaphoresis, oliguria, confusion) and anemia (eg, pallor, diaphoresis). Patients with lesser degrees of
bleeding may simply have mild tachycardia (heart rate > 100). Orthostatic changes in pulse (a change of > 10 beats/min)
or BP (a drop of ≥ 10 mm Hg) often develop after acute loss of ≥ 2 units of blood. However, orthostatic measurements are
unwise in patients with severe bleeding (possibly causing syncope) and generally lack sensitivity and specificity as a
measure of intravascular volume, especially in elderly patients.

Diagnostic Studies: CBC , NCT, Upper GI endoscopy, and colonoscopy.

Risk Factors: Several predisposing factors have been identified, including a history of a GI bleed and the use of aspirin,
nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anticoagulants, alcohol, and cigarettes. Alterations of the
GI mucosa, such as in esophagitis, gastric or duodenal ulcers, polyps, diverticuli, inflammatory bowel disease, colitis, and
prior intestinal anastomosing surgeries, must also be considered. Additional risk factors include vascular abnormalities,
such as esophageal, gastric, and intestinal varices seen in cirrhosis, and hemorrhoids, angiodysplasia, and other vascular
malformations such as hereditary hemorrhagic telangiectasias. Coagulopathies, anal fissures, and GI malignancies may
also predispose to GI bleeding.