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Front Matter |
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Abstract
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Abstract
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Stabilization of Patients Presenting with Upper Gastrointestinal Bleeding |
C. Cameron McCoy,Mark L. Shapiro |
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Abstract
Paleopathological evidence and descriptions of upper gastrointestinal bleeds (UGIB), i.e., proximal to the ligament of Treitz, are limited and sometimes inconclusive. The earliest potential reference to UGIB can be traced to the Ebers Papyrus (circa 1550 BC) describing a “blood-nest” in a patient who acutely turned pale and later expired (Brothwell DR, Sandison AT. Diseases in antiquity: a survey of the diseases, injuries, and surgery of early populations. Springfield, Ill.: Thomas; 1967. xix, 766 p.). A more conclusive familiarity of peptic ulcer pathology was noted by Roman scientists during the first century and thus we know that UGIB have been known for at least 2000 years (Majno G. The healing hand: man and wound in the ancient world. Cambridge, MA: Harvard University Press; 1975. xxiii, 571 p., 6 leaves of plates p.). Risk factors for UGIB were most likely omnipresent and, as such, suffering from UGIB has more than likely always plagued humans.
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Urgent Workup for Upper Gastrointestinal Bleeding |
Mohan K. Mallipeddi M.D.,Sandhya A. Lagoo-Deenadayalan |
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Abstract
Acute upper gastrointestinal bleeding afflicts thousands of patients each year, and can range from a mere nuisance to a life threatening condition. The underlying cause is most often peptic ulcer disease, gastritis, or varices. Infrequent causes include esophagitis, cancer, aorto-enteric fistulae, hemobilia, and arteriovenous malformations. This chapter elaborates on the rapid assessment and risk stratification of patients presenting with acute upper gastrointestinal bleeding. We discuss how endoscopy and other modalities aid in the localization and treatment of the bleeding source.
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Management of Esophageal Variceal Bleeding |
Demetrios Tzimas M.D.,Juan Carlos Bucobo M.D.,Dana Telem M.D. |
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Abstract
Variceal bleeding is a fatal complication of portal hypertension, which can be secondary to cirrhosis or various disorders that lead to increased portal pressures in a patient with preserved hepatic function. Current guideline recommendations base prophylaxis on the size of the varices and their likelihood of bleeding based on their endoscopic appearance and the severity of liver disease. Non-selective beta blockers are the mainstay of medical primary prophylaxis. In active variceal bleeding, medications are given to decrease portal pressures and endoscopy is performed with variceal band ligation to stop bleeding. For secondary prophylaxis, a combination of beta blockers and variceal band ligation is used to prevent re-bleeding. If acute variceal bleeding treated by endoscopy with band ligation fails to control bleeding, interventional radiology can be performed for a transjugular intrahepatic portosystemic shunt procedure or a surgical consultation should be called for evaluation for portacaval shunting to decompress the portal system.
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Management of Dieulafoy’s Lesions |
Victoria Bendersky,Alexander Perez M.D. |
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Abstract
Dieulafoy’s lesion is a difficult-to-diagnose, potentially life-threatening gastrointestinal bleeding condition. It is a vascular abnormality that consists of a large caliber-persistent tortuous artery with no apparent pathology but a small mucosal defect that resulted in eruption. The cause of the actual rupture is not clearly understood. The diagnostic modality of choice is endoscopy, primarily for its concomitant treatment possibilities. There is no general consensus on treatment of Dieulafoy’s lesion, but, as in diagnosis, endoscopy emerged as the preferred mode for management. Endoscopic treatments are organized into three groups—injection, mechanical, thermal; combined treatments are preferred to monotherapy as the success rate is higher. Due to recent advances in interventional radiology, angiography became the second choice of treatment for Dieulafoy’s lesion. Although in the past surgery was common in management of this condition, its role has been reduced for only the cases that failed under the first two modalities.
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Management of Bleeding Peptic Ulcer Disease |
Brian Ezekian,Alexander Perez M.D. |
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Abstract
Bleeding from peptic ulcers can have severe consequences. Most patients are managed with fluid resuscitation and when necessary hemostasis can be achieved via an endoscopic approach. While rebleeding after a successful endoscopic procedure is rare it may require a repeat endoscopy. Patients who do not respond to this initial approach may benefit from direct surgical control of the bleeding with oversewing of the ulcer with or without additional acid-suppressing procedures such as the vagotomy and antral resection. Patients who are deemed too high risk for surgery may benefit from angiographic embolization of the bleeding ulcer that has continued to bleed or has failed other measures.
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Management of Unusual Sources of Upper GI Bleeding |
Purvi Y. Parikh M.D., F.A.C.S. |
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Abstract
Recognizing unusual sources of upper GI bleeding is important in evaluating individual patients who present diagnostic dilemmas and in promptly managing patients with uncommon but potentially catastrophic bleeding sources. As upper GI bleeds are relatively common, the probability of encountering a patient with an unusual source of bleeding is likely at some point; therefore, understanding the diagnosis and management of these uncommon pathologic processes is essential in caring for patients with upper gastrointestinal bleeding.
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Mallory–Weiss Syndrome |
Joshua P. Spaete M.D.,M. Stanley Branch M.D. |
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Abstract
Gastrointestinal hemorrhage caused by gastroesophageal laceration was first reported by Quincke in 1879; however, the association with retching and vomiting was described by Mallory and Weiss in 1929 (Mallory and Weiss, Am J Med Sci, 178:506–514, 1929; Quincke, Deutsch Arch Klin Med, 24(72), 1879). The prevalence of Mallory–Weiss syndrome has been reported at between 3 and 15 % of all patients with acute upper gastrointestinal bleeding (Sugawa et al., Am J Surg, 145(1):30–3, 1983; van Leerdam, Best Pract Res Clin Gastroenterol, 22(2):209–24, 2008; Yin et al., Eur J Intern Med, 23(4):e92–6, 2012). Mortality associated with Mallory–Weiss tears has been shown to be similar to gastric and duodenal ulcers in at least one series (Marmo et al., Gastrointest Endosc, 75(2):263–72, 272.e1, 2012). The occurrence of gastroesophageal laceration without hemorrhage is difficult to quantify and their clinical significance is debatable.
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Diagnosis and Management of Bleeding Small Bowel Tumors |
Maria S. Altieri M.D., M.S.,Aurora D. Pryor M.D. |
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Abstract
The small intestine is a rare source for upper gastrointestinal (GI) bleeding, as it accounts for only 5 % of cases. However, it is the most common cause of obscure GI bleeding and should thus be considered for all patients with GI bleeding and no source by standard endoscopic examination. Diagnosis has been historically difficult due to limited means of gaining access; however newer techniques have improved our diagnostic and therapeutic abilities. Small bowel tumors represent the second most common cause of small bowel bleeding after vascular malformations. The aim of this chapter is to examine the diagnostic and management approaches to the patient with bleeding small bowel tumors.
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Management of Bleeding from the Bile Duct |
Cecilia T. Ong,Kevin N. Shah |
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Abstract
Hemobilia, bleeding originating from the biliary tract or gallbladder, is an uncommonly encountered clinical entity that is most frequently the result of accidental or iatrogenic trauma. Other causes include gallstones, inflammation, vascular disorders, and neoplasms. Manifestations of hemobilia range from minor morbidity to life-threatening hemorrhage, and diagnostic workup by direct or radiographic visualization depends on the presentation. Hemodynamically stable patients can undergo conservative management, and for those patients requiring intervention, angiographic approaches have become the mainstay. Surgical intervention is required if nonoperative measures fail. Clinical suspicion is an important element of diagnosis and subsequent management of hemobilia.
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Management of Bleeding from the Pancreas |
Scott Dolejs M.D.,Eugene P. Ceppa M.D. |
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Abstract
Acute hemorrhage originating from the pancreas is the least common form of gastrointestinal bleeding. Patients typically present with a triad of epigastric abdominal pain, intermittent gastrointestinal hemorrhage, and hyperamylasemia. Diagnosis is challenging but can be made through a combination of upper endoscopy, endoscopic retrogradge cholangiopancreatography, endoscopic ultrasound, computed tomography angiography, and angiography. First line treatment in stable patients is endovascular. In unstable patients, operative intervention is required.
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Abstract
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Urgent Workup of Lower Gastrointestinal Bleeding |
Megan Turner M.D.,Leila Mureebe M.D., M.P.H., F.A.C.S. |
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Abstract
Lower gastrointestinal bleeding occurs at a rate of 20 cases per 100,000 persons per year with a similar overall mortality to upper gastrointestinal bleeding. Prognosis is favorable, with the majority of bleeding episodes ceasing without intervention. The etiology of bleeding varies by age, and the correct diagnosis is paramount in subsequent management. The most common etiologies are colonic diverticulosis, benign anorectal disease, inflammatory bowel disease, malignancy, and angiodysplasia. Prompt resuscitation and implementation of critical care provide stability for subsequent diagnostics including colonoscopy, arteriography, and tagged red blood cell scan.
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Bleeding Hemorrhoids |
Zhifei Sun M.D.,Mohamed A. Adam M.D.,Julie K. M. Thacker M.D. |
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Abstract
Symptomatic hemorrhoid disease is prevalent and can significantly impact a patient’s quality of life. Management options for bleeding hemorrhoid disease are diverse, ranging from conservative measures to a variety of office and operating room procedures, depending on severity. In this review, the authors discuss the diagnosis and management of bleeding hemorrhoids.
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Management of Colonic Diverticular Bleeding and Bleeding Colitis |
Mohamed A. Adam M.D.,Zhifei Sun M.D.,John Migaly |
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Abstract
Colonic diverticular bleeding and colitis account for the majority of cases of lower gastrointestinal bleeding, with diverticular bleeding being by far the most common etiology. In contrast to diverticulitis, colonic diverticular bleeding most commonly originates in the ascending colon. Management of diverticular bleeding should start with adequate volume resuscitation, followed by colonoscopic localization and control of the bleeding site. Selective angiography may be employed for those who cannot undergo colonoscopy or underwent unsuccessful colonoscopic evaluation or treatment. Surgery is reserved for intractable diverticular bleeding. Bleeding from colitis is usually intermittent and self-limited. In hemodynamically stable patients with colitis bleeding, treatment should be aimed at control of the source of inflammation. If hemodynamic stability is compromised or if bleeding is severe, angiography and/or emergent resection should be considered.
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Colonic Arteriovenous Malformations |
Zhifei Sun M.D,Mohamed A. Adam M.D,Christopher R. Mantyh M.D. |
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Abstract
Arteriovenous malformations are degenerative vascular lesions of the gastrointestinal tract that result in lower gastrointestinal bleeding, especially in the elderly. Although self-limiting in most cases, symptomatic arteriovenous malformations can present with massive bleeding in 15 % of cases. This review discusses the clinical presentation, diagnostic workup, and management of colonic arteriovenous malformations.
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Bleeding Colorectal Tumors |
Cristan E. Anderson M.D., M.P.H.,Paula I. Denoya M.D. |
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Abstract
Colorectal tumors are the third most common source of acute lower gastrointestinal bleeding, after diverticulosis and hemorrhoids. Additionally, tumors account for a very common source of chronic occult bleeding. The choice of approach to evaluation and management of acute and chronic lower gastrointestinal bleeding is based on the acuity of the situation. Acute bleeding focuses on stabilization of the patient, followed by localization of the bleeding source. Management will most likely be via endoscopic or angiographic approach, with surgical options reserved for those situations that cannot be managed otherwise. Chronic bleeding is most commonly evaluated via colonoscopy. Once a diagnosis of colon or rectal cancer has been made, preoperative staging of the lesion followed by definitive surgery is the recommended approach.
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Abstract
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Evaluation of the Guaiac-Positive Patient |
Rebecca Burbridge M.D.,Melissa Teitelman |
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Abstract
One of the more common encounters a physician must deal with is the presence of occult gastrointestinal blood loss. The prevalence may reach up to 1 in 20 adults. The detection of occult blood is important because a person may lose up to 150 ml of blood from the proximal gastrointestinal tract before producing overt melena [Schiff et al. Am J Med Sci 203:409, 1942]. Before proceeding further, an important distinction must be made between . gastrointestinal blood loss and . gastrointestinal bleeding.
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发表于 2025-3-21 17:57:20
