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Gastroenterology
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
Melaena is the passage of black tarry stools caused by the presence of altered blood. This bleeding occurs above the level of the ileo- caecal valve and equates to more than 60 mL of blood loss. Even if a patient’s obstruction is causing some bleeding, the patient will usually not suffer from melaena due to absolute constipation.
Specific Diseases of Large Animals and Man
Published in Rebecca A. Krimins, Learning from Disease in Pets, 2020
Cattle are the other large animal species in which ‘gastric’ ulceration occurs. The forestomachs (rumen, reticulum, and omasum) precede the abomasum in ruminants. The abomasum is the equivalent of the monogastric stomach and abomasal ulceration is a distinct disease in this species. However, definitive ulcer diagnosis can be more challenging in cattle since endoscopy of the abomasum is not possible with the anatomical arrangement of the ruminant forestomachs. Clinical signs such as melena and anemia may provide a degree of suspicion of a bleeding ulcer. In contrast to the other species, ulcers in cattle perforate at a higher rate leading to either localized or generalized peritonitis. This may be due to the non-distinct clinical signs that are associated with ulcer disease in cattle and a failure to recognize the disease before significant progression. The prevalence of ulcers is reported as being up to 76% in calves and up to 20% in adult cattle at slaughter. As with the horse, pig, and humans, stress, diet, and NSAID use are involved in the pathogenesis of abomasal ulcers in cattle. A disease which crosses species such as gastric ulcer disease provides a unique comparative aspect to understanding the strong underlying causes of the disease in the different species and in man. Clearly, stress, diet, and NSAID drug use are common to each; however, at this time only the pig appears to have a strong relationship with Helicobacter infection in the pathogenesis of ulcer disease.
Locally Advanced Resectable Gastric Cancer
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Savio George Barreto, Shailesh V. Shrikhande
Most patients present with dyspepsia and/or iron deficiency anemia, as was the case in the patient presented. Symptoms such as anorexia, fatigue, and weight loss usually occur much later in the course of the disease. Symptoms of severe reflux followed by dysphagia may be seen in tumors of the cardia and gastroesophageal junction. Vomiting of undigested food within two to three hours of a meal raises the suspicion of gastric outlet obstruction and warrants further investigation. The passage of black tarry stools (melena) should also alert the treating doctor to the need for a gastroscopy.
Primary Angiosarcoma of the Gastrointestinal Tract: A Systematic Review of the Literature
Published in Journal of Investigative Surgery, 2022
Dimitrios Schizas, Aikaterini Mastoraki, Ilias Giannakodimos, Alexios Giannakodimos, Afroditi Ziogou, Ioannis Katsaros, Maximos Frountzas, Ioannis Koutelidakis, Pantelis Vassiliu, Emmanouil Pikoulis
Clinical presentation of PGAS depends on the location of the tumor and consists mainly of nonspecific symptoms [49]. The most frequent manifestations include GI bleeding, anal or abdominal pain and obstructive symptoms [13,50]. Nausea, vomiting, anemia, weight loss or parallel detection of a palpable mass and diarrhea may also occur in patients with PGAS [51,52]. In our study, GI bleeding and abdominal pain were observed in the majority of affected patients with small intestine and colonic angiosarcomas, while dysphagia and epigastralgia were typical symptoms of esophageal and gastric ones, respectively. The existence of melena comprises a poor indicator in small intestine vascular tumors. The mean interval between the appearance of clinical signs and diagnosis is estimated to be greater than 6 months [53].
Disseminated Burkitt lymphoma presenting as massive gastrointestinal bleed
Published in Baylor University Medical Center Proceedings, 2020
Prateek Suresh Harne, Jared Macklin, Thiruvengadam Muniraj
Sporadic BL has been most frequently reported as an intraabdominal mass with involvement of bone marrow, liver, kidney, and spleen, which was also observed in our case.10 The mass usually presents in the ileocecal area with symptoms such as obstruction, visible swelling, and/or pain; however, in our case, there was no such complaint. The first gastrointestinal complaint was melena followed by massive hematemesis, which is an infrequent observation. Though no endoscopic therapy was performed in our patient, endoscopy assisted with diagnosis. Early diagnosis is imperative given the high mortality rates with delays in chemotherapy initiation. The treatment of choice for aggressive BL in all stages is intensive systemic chemotherapy, as long as the patient is stable enough to receive it.11 However, patients with disseminated disease, increasing age, and central nervous system involvement seem to have inferior outcomes.12 BL presenting with gastrointestinal bleed is considered a hematological emergency and requires prompt treatment. In a study of 105 BL patients, Kasamon et al13 concluded that remission can scale up to 60% to 90% in adults if prompt diagnosis, referrals, and adequate early treatment are provided. A repeat endoscopy after 6 weeks of initiation of chemotherapy of our patient suggested complete remission with normalization of the gastric mucosa, thereby emphasizing prompt diagnosis and early adequate treatment of this condition.
Prospective cost analysis of early video capsule endoscopy versus standard of care in non-hematemesis gastrointestinal bleeding: a non-inferiority study
Published in Journal of Medical Economics, 2020
Salmaan Jawaid, Neil B. Marya, Michelle Hicks, Christopher Marshall, Kanishka Bhattacharya, David Cave
For patients with non-hematemesis gastrointestinal bleeding, the presenting complaints have poor localization value, necessitating a sequence of procedures that take time. Melena has traditionally been associated with an UGI source, prompting most gastroenterologists to perform an EGD as the first diagnostic procedure8–13. However, recent studies have suggested a shift in the epidemiology of gastrointestinal bleeding with a decrease in the true incidence of UGIB and the rising incidence of bleeding sources in other areas of the GI tract14–16. Melena can be associated with bleeding anywhere from the oropharynx to the right colon17,18. As a result, in a retrospective study we have shown low diagnostic yields of EGD (esophagogastroduodenoscopy) and/or COL (colonoscopy) and a high diagnostic yield for VCE when done as a first diagnostic procedure in patients presenting with NHGIB19.