Approach To The Patient With Rectal Bleeding
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
With the advent of smaller-caliber, more easily tolerated upper intestinal panendoscopes capable of examining the entire esophagus, stomach and duodenum, passage of a flexible fiberoptic endoscope into the stomach is less traumatic than the passage of a nasogastric tube. Whenever upper gastrointestinal bleeding is seriously considered as a cause for colonic hemorrhage, an upper gastrointestinal endoscopic examination should be the first line of investigation, since information obtained from passage of the nasogastric tube may be misleading.33 Whenever upper gastrointestinal bleeding occurs, the endoscopic examination has been shown to be the best diagnostic procedure for the location of the site of bleeding.34 An endoscopic examination may be performed quickly at the bedside of the bleeding patient and yields considerably more diagnostic information than either passage of a nasogastric tube or an upper gastrointestinal barium X-ray series.
Gastroenterology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Common gastrointestinal symptoms are vomiting, diarrhoea and gastrointestinal bleeding. There is usually a mild underlying gastrointestinal disorder (for example atopic-associated cow’s milk protein allergy) with worsening of existing symptoms and development of new symptoms when the mother is with the child. The mother usually appears appreciative, co-operative and pleasant, is close to the child, reluctant to leave the hospital and, whenever possible, forms close relationships with the professional staff caring for the child. The father is usually distant (although the syndrome has been described in fathers). The average time from onset to diagnosis is 15 months.
Management of lower gastrointestinal bleeding
David Westaby, Martin Lombard in Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The key aspect of managing lower gastrointestinal bleeding is establishing the source of blood loss to allow appropriately directed therapy. Within the spectrum of presentation of these patients it is important to distinguish two groups – the more unusual presentation with an acute onset and the more common problem of occult gastrointestinal bleeding presenting with anaemia or being detected on the basis of positive faecal occult blood testing.
Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2020
Hai-Yang Lai, Ke-Tong Wu, Yang Liu, Zhao-Fei Zeng, Bo Zhang
Gastrointestinal bleeding can be caused by a variety of pathologies and they differ in onset, location, risk and clinical presentation. Emergency resuscitation should be preferred to any investigations for patients with active gastrointestinal bleeding who are unstable [1,27]. Upper endoscopy and colonoscopy are still the mainstay for the diagnosis and treatment of gastrointestinal bleeding. However, there are several limitations of endoscopy in a setting of acute gastrointestinal bleeding, including inadequate bowel preparation, the influence of large blood clots and fecal content, as well as risks associated with sedation and perforation. Therefore, the definite or potential source of bleeding can be obscured by these limitations, resulting in a high rate of non-diagnostic endoscopic examinations. In our study, 76 of the 158 patients underwent endoscopic examination before angiography, and bleeding was confirmed in 40 patients (52.6%). Among them, endoscopic hemostasis was performed but failed in 26 patients, and endoscopic hemostasis was difficult to perform in the other 14 patients due to vascular malformation, intestinal mass and intestinal diffuse bleeding. The remaining 82 patients did not undergo endoscopic examination before angiography, the causes of which included poor gastrointestinal preparation for massive bleeding, hemorrhagic shock, lack of cooperation with the endoscopic examination, and bleeding caused by gastrointestinal tumors.
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
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).
Related Knowledge Centers
- Bleeding
- Gastrointestinal Tract
- Hematemesis
- Mouth
- Blood
- Melena
- Rectum
- Coffee Ground Vomiting
- Hematochezia
- Iron-Deficiency Anemia