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Management of lower gastrointestinal bleeding
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Lower gastrointestinal bleeding includes any source of bleeding distal to the ligament of Treitz [1]. However, upper gastrointestinal bleeding may mimic a lower gastrointestinal bleed, presenting with similar symptoms and signs in up to 10% of patients [2].
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Angiography is used most commonly in the investigation of upper gastrointestinal bleeding that is not identified using endoscopy. Therapeutic embolisation may also be of value in the treatment of bleeding in patients in whom surgery is difficult or inadvisable. In expert centres embolisation now
Haematemesis in Pregnancy
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Shahana Shahid, Nishchay Chandra
As with all cases of upper gastrointestinal bleeding, clinical evaluation is key to determining the severity of the bleeding. Assessment of the woman’s haemodynamic status forms the mainstay of the initial management and will determine the need for prompt fluid resuscitation and urgent endoscopy. Calculating a severity score for bleeding can help ‘risk stratify’ patients for urgency of endoscopy (Table 1).
Application of endoscopic purse-string sutures in high-risk peptic ulcer hemorrhage: preliminary experience of 38 cases
Published in Scandinavian Journal of Gastroenterology, 2023
Jingxian Hu, Miao Jiang, Hongyan Liu, Hao Zhou, Yajie Wang
Through clinical manifestations and laboratory examination, patients with acute upper gastrointestinal bleeding were screened out. All patients were assessed by the Blatchford score before endoscopy, and patients with ≥ 6 points were examined by emergency endoscopy within 24 h [15]. Patients meeting the inclusion criteria signed informed consent. After full communication between the endoscopy physician and the patient or the patient's representative, the patients were selected for nylon string purse suture or standard hemostasis under endoscopy. All the ulcer lesions were evaluated by the Forrest grading risk degree: Forrest Ia spray blood bleeding, Forrest Ib active ooze, Forrest IIa blood vessels exposed, Forrest IIb blood clot attached, Forrest IIc black base, Forrest III base clean. Forrest Ia - Forrest IIa ulcers are an independent risk factor for persistent bleeding or rebleeding and are considered high-risk ulcers.
Association of Candida esophagitis with acute esophageal necrosis
Published in Baylor University Medical Center Proceedings, 2022
Muhammad Sheharyar Warraich, Bashar Attar, Shazaq Khalid, Muhammad Ali Khaqan
AEN is exceedingly rare, with an incidence of 0.01% to 0.28%.3 It was first described in 1914 by Brekke et al but did not get its current name until 1990.2,4 Some commonly described risk factors associated with this condition include renal insufficiency, diabetes mellitus, hypertension, atherosclerotic vascular disease, sepsis, and hypothermia.5 Mucosal barrier dysfunction seems to be the common endpoint of the different theories that have attempted to explain the pathogenesis of AEN. AEN typically occurs in critically ill patients who have multiple chronic conditions. It usually presents with upper gastrointestinal bleeding, but patients may display other symptoms like nausea, vomiting, dysphagia, and abdominal pain. Diagnosis is made on direct visualization during esophagogastroduodenoscopy. Biopsy is associated with a small risk of perforation and is supportive but not required for the diagnosis. It can help rule out infections and some other similar-appearing conditions like melanosis, melanoma, and acanthosis nigricans. Treatment is mostly supportive and includes aggressive hydration, proton pump inhibitors, and antimicrobials for cases that have a histologically confirmed infection. Total parenteral nutrition is a consideration for such patients due to the risk of perforation associated with the use of enteral tubes. Surgical management is necessary for the subset of patients whose disease is complicated by perforation or mediastinal disease. AEN is known to have a high mortality rate, with one study suggesting a rate up to 28%.6
Predictive factors of therapeutic intervention in on-call endoscopy for suspected gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2018
Chan Hyung Lee, Hyuk Yoon, Yoon Jin Choi, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Dong Ho Lee, Joo Sung Kim
It is interesting that in a study by Adamopoulos et al. [25], red blood on nasogastric aspiration, hemodynamic instability, hemoglobin (>8 g/dL) and white blood cell count (>12,000/μL) significantly predicted active upper gastrointestinal bleeding as pre-endoscopic variables among patients who underwent on-call endoscopies in the multivariate analysis. We included patients with suspected upper and/or lower gastrointestinal bleeding, including hospitalized patients, whereas Adamopoulos et al. limited the subjects only for upper gastrointestinal bleeding cases and excluded patients who presented symptoms of bleeding during hospitalization for other illnesses. Gastrointestinal bleeding occurs regardless of location in the hospital, and the focus of the bleeding is often difficult to clearly differentiate just by clinical symptoms such as melena and hematochezia. Therefore, our study design implies a more practical concern in clinical decision. In addition, 26.8% of patients were evaluated as having active upper gastrointestinal bleeding and those underwent therapeutic intervention in a study by Adamopoulos et al. In contrast, more than 50% of patients who had on-call gastroscopy underwent hemostasis in this study. These differences can be explained by the on-call system of Seoul National University Bundang Hospital, where gastroenterology junior staffs thoroughly reevaluate patients and perform on-call endoscopies in high-risk patients.