Differential Diagnosis Brief Description of the disease

Upper GI Bleed  A peptic ulcer is defined as disruption of the mucosal integrity of the stomach and/or
duodenum leading to a local defect or excavation due to active inflammation
 Peptic ulcers are the most common cause of UGIB, accounting for ~50% of UGIB
hospitalizations.
Peptic Ulcer
 Peptic ulcer classically causes epigastric gnawing or burning, often occurring nocturnally
and promptly relieved by food or antacids.
 PUD encompasses both gastric and duodenal ulcers (DUs).
 H. pylori and NSAIDs are the most common risk factors for PUD.
 Mallory-Weiss tears account for ~2–10% of UGIB hospitalizations.
 The classic history is vomiting, retching, or coughing preceding hematemesis, especially
in an alcoholic patient.
Mallory-Weiss Tears
 Bleeding from these tears, which are usually on the gastric side of the gastroesophageal
junction, stops spontaneously in 80–90% of patients and recurs in only 0–10%.
 Endoscopic therapy is indicated for actively bleeding Mallory-Weiss tears.
 Esophageal varices are dilated submucosal distal esophageal veins connecting the
portal and systemic circulations.
 This happens due to portal hypertension (most commonly a result of cirrhosis),
Esophageal varices
resistance to portal blood flow, and increased portal venous blood inflow.
 The most common fatal complication of cirrhosis is variceal rupture; the severity of liver
disease correlates with the presence of varices and risk of bleeding.
 The esophagus is infrequently the source for significant hemorrhage. When it does
occur, it is most commonly the result of esophagitis.
 Esophageal inflammation secondary to repeated exposure of the esophageal mucosa to
Erosive esophagitis the acidic gastric secretions in gastroesophageal reflux disease leads to an inflammatory
response that can result in chronic blood loss.
 Ulceration may accompany this, but the superficial mucosal ulcerations generally do
not bleed acutely and are manifested as anemia or guaiac positive stools.
Dieulafoy lesions  Dieulafoy lesions are vascular malformations found primarily along the lesser curve of
the stomach within 6 cm of the gastroesophageal junction, although they can occur
elsewhere in the GI tract.
 They represent rupture of unusually large vessels (1 to 3 mm) found in the gastric
submucosa.
 Erosion of the gastric mucosa overlying these vessels leads to hemorrhage.
  The mucosal defect is usually small (2 to 5 mm) and may be difficult to identify.
Lower GI Bleed  Diverticulosis is a clinical condition in which multiple sac-like protrusions (diverticula)
develop along the gastrointestinal tract. Though diverticula may form at weak points in
the walls of either the small or large intestines, the majority occur in the large intestine
Diverticular disease
(most commonly the sigmoid colon).
 Diverticulosis is thought to occur as a result of peristalsis abnormalities (e.g., intestinal
spasms), intestinal dyskinesia, or high segmental intraluminal pressures.
 Inflammatory bowel disease is characterized by repetitive episodes of inflammation of
the gastrointestinal tract caused by an abnormal immune response to gut microflora. 
 Inflammatory bowel disease (IBD) encompasses two types of idiopathic intestinal
disease that are differentiated by their location and depth of involvement in the bowel
wall.
Inflammatory Bowel
 Ulcerative colitis (UC) involves diffuse inflammation of the colonic mucosa. Most often
Disease
UC affects the rectum (proctitis), but it may extend into the sigmoid (proctosigmoiditis),
beyond the sigmoid (distal ulcerative colitis), or include the entire colon into the cecum
(pancolitis).
 Crohn disease (CD) results in transmural ulceration of any portion of the
gastrointestinal tract (GI) most often affecting the terminal ileum and colon. 
 Intussusception takes place when one segment of bowel telescopes into an adjacent
bowel segment, causing an obstruction and even intestinal ischemia.
 This process can lead to multiple complications such as bowel obstruction, bowel
Intussusception
necrosis, and sepsis.
 The disease process is much more common in the pediatric population and uncommon
in adults, but when present is likely due to a pathological lead point such as neoplasm.
Hemorrhoidal disease  Hemorrhoids, also known as piles, and hemorrhoidal disease refer to the state of
symptoms attributed to the vascular cushions present in the anal canal.
 Hemorrhoids are naturally occurring vascular tissues within the submucosa in the anal
canal and comprise loose connective tissue, smooth muscle (Treitz’s muscle), and blood
vessels with many arteriovenous connections (why hemorrhoidal bleeding is typically
bright red). 
 Hemorrhoids classify into four grades: grade I hemorrhoids bulge into the anal canal
and do not prolapse; grade II hemorrhoids prolapse during defecation and reduce
spontaneously; grade III hemorrhoids prolapse and require manual reduction; grade IV
hemorrhoids prolapse and are irreducible.
  Anal fissure is a superficial tear in the skin distal to the dentate line and is a cause of
frequent emergency department visits.
 In most cases, anal fissures are a result of hard stools or constipation, as well as injury.
Anal fissure
 Anal fissures can be acute (lasting less than six weeks) or chronic (more than six weeks).
 The majority of anal fissures are considered primary and typically occur at the posterior
midline.