Abdominal emergencies
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
The protocol for managing upper gastrointestinal bleeding is summarised in Figure 7.3. AdmitNBMInsert two large-bore cannulasFluid resuscitation. If the patient has a severe bleed (active haematemesis and/or haematemesis with shock), or a Hb < 10 g/dl give O −ve blood but preferably cross-matched blood if availableUrinary catheter with accurate fluid balanceCorrect clotting if derangedCommence PPI84empirically (80 mg omeprazole i.v. stat, followed by 8 mg/h infusion for 72 h in severe bleeds)Consider central venous accessUrgent OGD if the patient has a severe bleed, otherwise it may be performed within 24 h of admission.
Haematemesis in Pregnancy
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
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).
Laser Photocoagulation: Experimental And Clinical Studies
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Upper gastrointestinal bleeding is a commonly encountered problem in clinical medicine and gastroenterology. There are approximately 100 admissions for gastrointestinal bleeding per 100,000 population per year.1 The care of patients with upper gastrointestinal bleeding has improved in the past ten years with the use of central intravascular pressure monitoring and intensive care units. However, despite advances in the care of critically bleeding patients, the mortality from upper gastrointestinal bleeding has remained constant at 10% for several decades.2 This lack of improved survival has been attributed to the increasing age of bleeding patients and the associated, often life-threatening, underlying illnesses. In the past ten years, there have been dramatic advances in the technology of fiberoptic endoscopy. Many investigators have sought to find a method to control upper gastrointestinal bleeding using endoscopic access to the gastrointestinal tract.3 Techniques investigated include laser photocoagulation, direct thermal coagulation,4, 5 electrocoagulation,6, 7, 8 and the application of topical hemostatic agents such as cyanoacrylate glues9, 10 and clotting factors.11, 12 In his Chapter, Dr. Auth has presented the physics of lasers and engineering aspects of tissue interaction. In this Chapter, we will discuss the role of laser photocoagulation in upper gastrointestinal bleeding. We will discuss some of the technical and biologic aspects of the lasers being studied, the animal work reported, and the American clinical experience. Cotton and Vallon will present the status of the non American clinical trials in the next Chapter. We will comment on the biologic effects of lasers, the medical aspects of laser delivery systems, the necessity for gas-jet assistance, removal of insufflated gas, laser safety, and some of the problems with laser photocoagulation that are yet to be solved.
Haematemesis related to orthodontic treatment with Nance palatal arch: a case report
Published in Journal of Orthodontics, 2018
Romeo Patini, Anna Alessandri Bonetti, Andrea Camodeca, Edoardo Staderini, Patrizia Gallenzi
Haematemesis is the most common sign of acute upper gastrointestinal bleeding, accounting for nearly 50 per cent of patients complaining of oral bleeding (Cappell and Friedel 2008). This sign is of a particular interest, because it can represent a potentially life-threatening condition with a mortality of 5–10 per cent (Kasper et al. 2005). Peptic ulcers, acute erosive gastritis, varices, Mallory-Weiss syndromes, gastric cancers and angiodysplasias are considered to be the most common causes of upper gastrointestinal bleeding (Rathod et al. 2011). The American Society of Gastrointestinal and Endoscopic surgeon's guidelines recommend urgent endoscopy in actively bleeding patients (ASGE Standards of Practice Committee 1992). Specifically, esophagogastroduodenoscopy (EGD) is believed to be the safest and most appropriate method for diagnosis and controlling upper gastrointestinal bleeding in both children and adults (Fox 2000; Cleveland et al. 2012; Kim et al. 2014; Pezzullo et al. 2014). Because of this, EGD should be performed on patients with haematemesis as quickly as possible (Yu et al. 2016).
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
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.
Related Knowledge Centers
- Gastrointestinal Bleeding
- Gastrointestinal Tract
- Vomiting
- Esophagus
- Stomach
- Melena
- Duodenum
- Shock
- Peptic Ulcer Disease
- Gastric Erosion