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Approach To The Patient With Rectal Bleeding
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Bright-red blood diffusely coating the normal solid brown stool may occur with radiation colitis14 even years after the radiation therapy was administered. The rectum, being fixed in its position, is the portion of the gut most commonly affected during radiotherapy for pelvic neoplasm. Radiation tissue damage may stimulate neovascularization of the mucosal surface and a propensity to bleed. Proctitis may also cause blood to coat a normal stool, but urgency is an almost invariable accompaniment. Bloody diarrhea, with or without mucus and pus, points to the presence of colonic inflammation, the most frequent cause of which is ulcerative colitis. Other specific inflammatory processes may cause diarrhea and bleeding, such as Yersinia enterocolitis, Campylobacter fetus, amebiasis, or bacterial infections.15
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Take a general colorectal and gynaecological history. Dysmenorrhoea, dyspareunia, cyclical rectal bleeding (occurs in up to one-third of patients but very few have involvement of the bowel mucosa) and painful defaecation just before menstruation are characteristic. Pain is relieved once menstruation starts. Occasionally bowel obstruction is caused. Differential diagnosis includes malignancy (primary or metastatic), diverticulitis, IBD, pelvic inflammatory disease (PID) and radiation colitis.
Oral examinations
Published in Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop, A Complete Guide to the Final FRCR 2B, 2011
Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop
Rectosigmoid stricture is a late complication of pelvic irradiation for cancers of the cervix, prostate, testes and bladder. The median interval for development of radiation colitis is 2 years. Colitis is secondary to ischaemia as a result of obliterative endarteritis which is followed by fibrosis. The strictures appear as generalised narrowing within the radiation field. Metallic radiotherapy markers are a clue to the diagnosis.
Potential applications of drug delivery technologies against radiation enteritis
Published in Expert Opinion on Drug Delivery, 2023
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
HA is a polyanionic natural polymer occurring as a linear polysaccharide composed of glucuronic acid and N-acetylglucosamine repeats via a β-1,4 linkage. It is the most versatile macromolecule present in the connective tissues of all vertebrates [97]. HA has unique physicochemical and biological properties, exhibiting desirable biocompatibility and biodegradability. HA has a wide range of biomedical applications such as osteoarthritis surgery, ocular surgery, plastic surgery, tissue engineering, and drug delivery [98]. HA can be cross-linked or conjugated with a variety of biological macromolecules, and it can encapsulate a variety of drugs in hydrogels. Moreover, the physiological significance of the interactions between HA and its main membrane receptor, CD44 (a cell-surface glycoprotein that modulates cell–cell interactions, cell adhesion, and migration), in pathological processes, such as UC and radiation colitis, is well recognized and this has resulted in extensive studies on colon drug delivery and inflammation targeting [99].
Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway
Published in Scandinavian Journal of Gastroenterology, 2021
Vendel A. Kristensen, Randi Opheim, Gøri Perminow, Gert Huppertz-Hauss, Trond Espen Detlie, Charlotte Lund, Svend Andersen, Bjørn C. Olsen, Ingunn Johansen, Asle W. Medhus, Simen Vatn, Stephan Brackmann, Christine Olbjørn, Jon Rove, Magne Henriksen, Emma Elisabeth Løvlund, May-Bente Bengtson, Tone Bergene Aabrekk, Tor Tønnessen, Florin Berge Vikskjold, Hussain Yassin, Svein Oskar Frigstad, Audun Hasund, Ole Høie, Katharina Schmidt, Raziye Boyar Cetinkaya, Roald Torp, Erik Skogestad, Hans Kristian Holm, Tahir Riaz Ahmad, Øistein Hovde, Carl Magnus Ystrøm, Batool Aballi, Arnt Sagosen, Aina Pedersen, Stein Dahler, Jens Pallenschat, Petr Ricanek, Marte Lie Høivik
All general practitioners and the private gastroenterology centers in the South-Eastern Health Region were informed of the ongoing study by letter and invited to refer all patients with symptoms and clinical findings suspicious of IBD to their local hospital. Individuals with suspected IBD based on referral letters were invited to participate in the study. Patients who fulfilled internationally accepted diagnostic criteria (Lennard-Jones criteria for adults [14], revised Porto criteria for children [15]) after initial diagnostic work-up were included as definite IBD cases. Patients with subtle findings indicative of IBD [on endoscopy or magnetic resonance imaging (MRI)], but who did not meet full diagnostic criteria, were also included and classified as ‘suspicion of small bowel IBD’ or ‘suspicion of large bowel IBD’. Patients with symptoms of IBD, but without endoscopic or histologic signs of inflammation, were classified as ‘symptomatic non-IBD controls’. These patients remained in the study as a control group. Exclusion criteria were other causes of acute or chronic bowel inflammation, i.e. infectious colitis, radiation colitis, diversion colitis, solitary rectal ulcer syndrome, graft versus host disease, diverticular colitis, medication associated colitis, ischemic colitis, microscopic colitis, and enema associated colitis.
Serological markers facilitate the diagnosis of Crohn’s disease
Published in Postgraduate Medicine, 2021
Patients with a suspected diagnosis of CD (n = 196) were recruited from the department of gastroenterology at West China Hospital, Sichuan University between June 2017 and September 2019. The final diagnoses were defined by the standard criteria for CD, Ulcerative colitis (UC), intestinal tuberculosis (TB), intestinal Bechet’s disease (BD), and cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), respectively [1,14–17]. Patients with enteric infections, ischemia, non-steroidal anti-inflammatory drug-induced ulceration, radiation colitis, and tumor were excluded. This study was performed with the permission of the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (No.ChiCTR2000037898).