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The patient with acute gastrointestinal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Rebecca Maindonald, Adrian Jugdoyal
Lower gastrointestinal bleeding is more common in the elderly; its presentation can range from minor bleeding to a life-threatening haemorrhage, with an associated mortality of 5% (NCEPOD 2016). Most cases of lower GI bleeding are self-limiting, responsive usually to resuscitative approaches including fluid and blood administration.
Complications in Laparoscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Shobhit Sengar
The management of patients with anastomotic bleeding should follow the same principles as the management of patients with lower gastrointestinal bleeding from other causes. Surgical intervention should be reserved for unstable patients, or those who fail conservative measures [51]. Initial management should be conservative with supportive care, including blood transfusions and correction of any underlying coagulopathy. Operative management should be considered early for patients with hemodynamic instability despite aggressive resuscitation. For persistent bleeding from a low anastomosis, a transanal operative approach is advocated. A proctoscopy is performed to evacuate clot, and bleeding points are suture ligated; for persistent bleeding from higher colorectal or ileocolic anastomoses, initial endoscopic management has been advocated.
Process Delivery in Colorectal Surgical Practice
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Similarly, the majority of patients with diverticular disease present with sepsis or obstruction. At least a third of all inflammatory bowel disease present to the front door with acute symptoms. A small number of patients will lower gastrointestinal bleeding will require urgent admission and investigation. Civil violence when it affects the large bowel will also need to be managed through the emergency admission unit.
Implementing screening for myocardial injury in non-cardiac surgery: perspectives of an ad-hoc interdisciplinary expert group
Published in Scandinavian Cardiovascular Journal, 2023
Dan Atar, Leiv Arne Rosseland, Ib Jammer, Kristin Moberg Aakre, Rune Wiseth, Marius Molund, Danielle M Gualandro, Torbjørn Omland
The most compelling evidence for PMI treatment in the postoperative setting comes from MANAGE, a RCT investigating dabigatran treatment in patients with MINS aged ≥45 years [55]. A total of 1,754 patients were randomised to dabigatran 110 mg bid or placebo within 35 days of non-cardiac surgery and a MINS diagnosis. Compared with placebo, patients randomised to dabigatran had reduced risk of a major vascular complication (11% vs 15%; HR 0.72; 95% CI 0.55–0.93; p = 0.0115), non-haemorrhagic stroke, peripheral arterial thrombosis, amputation, and symptomatic venous thromboembolism at 16 months (mean) follow-up [55]. Although major bleeding risk was not increased by treatment, some patients had increased risk of minor bleeding and lower gastrointestinal bleeding, but these were not clinically significant. Despite these promising results, the study was limited by a high drop-out rate (dabigatran prematurely discontinued in 46% of patients), and preoperative troponin measurements were not performed.
Utility of repeat colonoscopy within 1 year: a patient-level analysis
Published in Baylor University Medical Center Proceedings, 2023
Busara Songtanin, Abbie Evans, Sebastian Sanchez, Vanessa Costilla, Kenneth Nugent
The current US Preventive Services Task Force guidelines on colonoscopy for colorectal cancer (CRC) surveillance recommend screening all adults aged 50 to 75 years old as a grade A recommendation and adults aged 45 to 49 as a grade B recommendation. Recommendations on the interval between follow-up colonoscopies vary based on initial colonoscopy findings and focus primarily on the presence (number and histology) of polyps. Other indications include lower gastrointestinal bleeding, abnormal imaging, iron-deficiency anemia, and acute and chronic diarrhea.1 However, there are no established guidelines on when to repeat colonoscopies in patients presenting with new gastrointestinal symptoms within 1 year of prior colonoscopies. These situations likely require a careful analysis of the clinical presentation, prior colonoscopy results, and safety of any planned procedure. However, avoiding unnecessary colonoscopies is important. Previous studies have shown that overuse of repeat colonoscopies in patients at low risk of CRC has a high medical cost and may delay necessary procedures in other patients, especially with the currently limited number of providers.2–4 Overuse may also result in complications, such as colonic perforation, sepsis, and aspiration.
Out of sight for the endoscopist? Gastrointestinal bleeding after aortic repair
Published in Scandinavian Journal of Gastroenterology, 2022
Markus Busch, Klaus Stahl, Jan Fuge, Claudia Schrimpf, Nina RIttgerodt, Mark Greer, Young-Seon Mederacke, Axel Haverich, Heiner Wedemeyer, Benjamin Heidrich, Andrea Schneider, Henrike Lenzen, Ingmar Mederacke
Acute gastrointestinal bleeding is a frequent cause of emergency department attendance. The most common causes of upper gastrointestinal bleeding (UGIB) being peptic ulcer disease, followed by esophagitis, gastritis, duodenitis and variceal bleeding [1]. Lower gastrointestinal bleeding (LGIB) is commonly due to diverticular disease, hemorrhoids, colonics polyps or colitis [1]. The mainstay of bleeding remains upper and/or lower endoscopy, as recommended in various international [2–6] and national guidelines [7]. Using these approaches, GI bleeds are usually reliably identified. In the most recent ESGE guideline however, CT angiography prior to endoscopy has been recommended in patients with lower GI bleeding resulting in hemodynamic instability [2]. This may be particularly relevant in the context of aortoenteric fistulas (AEF), which represent a rare but important cause of both upper and lower gastrointestinal hemorrhage following aortic surgery, resulting in mortality rates of 50%−70% [8–10].