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==Causes of Upper GI Bleeding==
==Causes of Stroke==
There are many causes for upper GI hemorrhage.  Causes are usually anatomically divided into their location in the upper gastrointestinal tract.
===Ischemic Stroke===
Patients are usually stratified into having either '''[[esophageal varices|variceal]]''' or '''non-variceal''' sources of upper GI hemorrhage, as the two have different treatment algorithms and prognosis. 
====Thrombotic Stroke====
Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on:


The causes for upper GI hemorrhage include the following:
* '''Large vessel disease''' involves the common and [[internal carotid artery|internal carotids]], [[vertebral artery|vertebral]], and the [[Circle of Willis]]. Diseases that may form thrombi in the large vessels include (in descending incidence):
*[[Esophagus|Esophageal]] causes:
** [[Arteritis]]/[[vasculitis]]
** [[Esophageal varices]]
** [[Atherosclerosis]]
** [[Esophagitis]]
** [[Aortic dissection|Dissection]]
** [[Esophageal cancer]]
** [[Fibromuscular dysplasia]]
**Esophageal ulcers
** [[Giant cell arteritis]]
** [[Moyamoya syndrome]]
** Noninflammatory vasculopathy
** [[Takayasu arteritis]]
** [[Vasoconstriction]]
   
* '''Small vessel disease''' involves the intracerebral arteries, branches of the Circle of Willis, [[middle cerebral artery]], stem, and arteries arising from the distal vertebral and [[basilar artery]]. Diseases that may form thrombi in the small vessels include (in descending incidence):
** Lipohyalinosis (lipid hyaline build-up secondary to hypertension and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts)
** Microatheromas from larger arteries that extend into the smaller arteries (atheromatous branch disease)


*[[Stomach|Gastric]] causes:
====Embolic Stroke====
** [[Gastric ulcer]]
=====High Risk Cardiac Causes<ref name="ay">{{cite journal | author=  Ay H; Furie KL; Singhal A; Smith WS; Sorensen AG; Koroshetz WJ | title=  An evidence-based causative classification system for acute ischemic stroke | journal=  Ann Neurol | year=2005 | pages=688-97 | volume=58 | issue=5 | id=PMID 16240340}}</ref>=====
** [[Gastric cancer]]
* [[Antiphospholipid syndrome]]
** [[Gastritis]]
* [[Atrial fibrillation]] and [[paroxysmal atrial fibrillation]]
** [[Gastric varices]]
* Atrial or ventricular thrombus
** [[Gastric antral vascular ectasia]], or watermelon stomach
* Bioprosthetic and [[Artificial heart|mechanical heart]] valves
** [[Dieulafoy's lesion]]s
* Chronic myocardial infarction together with [[ejection fraction]] <28 percent
* [[Coronary artery bypass graft]] ([[CABG]]) surgery
* [[Dilated cardiomyopathy]]
* [[Infective endocarditis]]
* [[Left atrial myxoma]]
* [[Libman-Sacks endocarditis]]
* [[Marantic endocarditis]] from cancer
* [[Papillary fibroelastoma]]
* Recent [[myocardial infarction]] (within one month)
* Rheumatic mitral or [[aortic valve]] disease
* [[Sick sinus syndrome]]
* Sustained [[atrial flutter]]
* Symptomatic [[congestive heart failure]] with ejection fraction <30 percent


*[[Duodenum|Duodenal]] causes:
=====Potential Cardiac Causes=====
**[[Duodenal ulcer]]
* Atrial septal [[aneurysm]]
** Vascular malformations, including aorto-enteric fistulae. Fistulae are usually secondary to prior vascular surgery and usually occur at the proximal anastomosis at the third or fourth portion of the duodenum where it is retroperitoneal and near the aorta.<ref name="pmidpending">{{cite journal |author=Graber CJ et al |title=A Stitch in Time — A 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue |journal=New Engl J Med |volume=357 |issue= |pages=1029-1034 |year=2007 |pmid= |doi=|url=http://content.nejm.org/cgi/content/full/357/10/1029}}</ref><ref name="pmid12704326">{{cite journal |author=Sierra J, Kalangos A, Faidutti B, Christenson JT |title=Aorto-enteric fistula is a serious complication to aortic surgery. Modern trends in diagnosis and therapy |journal=Cardiovascular surgery (London, England) |volume=11 |issue=3 |pages=185-8 |year=2003 |pmid=12704326 |doi=}}</ref><ref name="pmid15279179">{{cite journal |author=Cendan JC, Thomas JB, Seeger JM |title=Twenty-one cases of aortoenteric fistula: lessons for the general surgeon |journal=The American surgeon |volume=70 |issue=7 |pages=583-7; discussion 587 |year=2004 |pmid=15279179 |doi=}}</ref>
* Atrial septal aneurysm with patent foramen ovale
** Hematobilia, or bleeding from the biliary tree
* Complex atheroma in the [[ascending aorta]] or proximal arch
**[[Hemosuccus pancreaticus]], or bleeding from the [[pancreatic duct]]
* Isolated left atrial smoke on echocardiography (no [[mitral stenosis]] or atrial fibrillation)
* Left ventricular aneurysm without thrombus
* Mitral annular calcification
* [[Patent foramen ovale]]
 
====Systemic Hypoperfusion (Watershed stroke)====
* [[Cardiac arrest]]
* Cardiac arrhythmias
* Reduced [[cardiac output]] as a result of
** Bleeding
** [[Myocardial infarction]]
** [[Pericardial effusion]]
** [[Pulmonary embolism]]
 
[[Hypoxia (medical)|Hypoxemia]] (low blood oxygen content) may precipitate the hypo-perfusion.
 
===Hemorrhagic Stroke===
====Intracerebral Hemorrhage====
* [[Amyloid angiopathy]]
* [[Haemophilia|Bleeding disorders]]
* [[Hypertension]]
* [[Drug use|Illicit drug use]] (e.g., [[amphetamines]] or [[cocaine]])
* Trauma
* Vascular malformations
 
==References==
{{Relist|2}}


==References==
==References==

Revision as of 12:43, 28 July 2014


Causes of Stroke

Ischemic Stroke

Thrombotic Stroke

Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on:

  • Small vessel disease involves the intracerebral arteries, branches of the Circle of Willis, middle cerebral artery, stem, and arteries arising from the distal vertebral and basilar artery. Diseases that may form thrombi in the small vessels include (in descending incidence):
    • Lipohyalinosis (lipid hyaline build-up secondary to hypertension and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts)
    • Microatheromas from larger arteries that extend into the smaller arteries (atheromatous branch disease)

Embolic Stroke

High Risk Cardiac Causes[1]
Potential Cardiac Causes
  • Atrial septal aneurysm
  • Atrial septal aneurysm with patent foramen ovale
  • Complex atheroma in the ascending aorta or proximal arch
  • Isolated left atrial smoke on echocardiography (no mitral stenosis or atrial fibrillation)
  • Left ventricular aneurysm without thrombus
  • Mitral annular calcification
  • Patent foramen ovale

Systemic Hypoperfusion (Watershed stroke)

Hypoxemia (low blood oxygen content) may precipitate the hypo-perfusion.

Hemorrhagic Stroke

Intracerebral Hemorrhage

References

Template:Relist

References

  1. ↑ Ay H; Furie KL; Singhal A; Smith WS; Sorensen AG; Koroshetz WJ (2005). "An evidence-based causative classification system for acute ischemic stroke". Ann Neurol. 58 (5): 688–97. PMID 16240340.

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The upper part of the GI tract will usually cause black stools due to:


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 









Primary treatment option
Atropine
❑ Administer a first dose 0.5 mg IV bolus
❑ Repeat every 3-5 minutes
❑ Administer a maximum dose of 3 mg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary treatment options
If atropine ineffective:
❑ Administer dopamine infusion (2-10 mcg/kg/min)
OR
❑ Administer epinephrine infusion (2-10 mcg/min)
OR
❑ Proceed with transcutaneous pacing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Consult a cardiologist
❑ Consider transvenous pacing
 
 
 
 
 
 






References

Overview

Causes

Life Threatening Causes

Common Causes

Diagnosis

Focused Initial Rapid Evaluation

Complete Evaluation

 
 
 
 
 
 
 
 
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Treatment

Do's

Don'ts

References

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