Obscure GI Bleeding
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This document discusses obscure gastrointestinal bleeding, which refers to bleeding from the small intestine. Obscure bleeding accounts for 5-10% of GI bleeding cases. The common causes of small bowel bleeding differ between younger and older patients. Initial evaluation involves endoscopy of the upper and lower GI tract, but these may miss lesions. Additional procedures like push enteroscopy, capsule endoscopy, and deep enteroscopy can be used to evaluate the small bowel in cases of suspected small bowel bleeding. Localizing the bleeding site can be challenging and may require multiple procedures.
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3) Diagnosis is usually made clinically but imaging like ultrasound or CT scan can help if the diagnosis is uncertain. The Alvarado score is also used to evaluate the likelihood of appendicitis.
Ascites
This document provides information on ascites including its definition, causes, diagnosis, and management. Ascites is defined as the accumulation of free fluid in the peritoneal cavity, most often caused by liver cirrhosis (75% of cases), malignancy, or heart failure. Diagnosis involves history, physical exam finding shifting dullness or fluid wave, and abdominal ultrasound or paracentesis. Initial ascites management consists of sodium restriction, diuretics, and large volume paracentesis for refractory ascites.
Approach to patients with upper gi bleeding
This document provides an overview of a seminar on gastrointestinal bleeding. It begins with an introduction and outline. It then covers topics like the anatomy of the GI tract and sources of bleeding. Diagnostic assessments including history, exams, and tests are reviewed. Approaches to resuscitation, classification of shock, and fluid management are outlined. Etiologies of upper and lower GI bleeding like ulcers, varices, and tumors are summarized. Endoscopic and surgical management strategies are also discussed. Risk factors for poor prognosis with GI bleeding are listed. The document concludes with a risk score to predict need for intervention in GI bleeding cases.
Upper gi bleeding
This document summarizes the presentation, evaluation, and management of a 70-year-old man with upper gastrointestinal bleeding due to esophageal varices from liver cirrhosis. Key points include: the patient presented with blood vomiting and black stools; examination found dehydration and signs of liver disease; endoscopy revealed esophageal varices that were banded to stop the bleeding. Variceal bleeding is a complication of portal hypertension in cirrhosis and has high rebleeding risks. Initial stabilization is followed by endoscopic treatment, vasoactive drugs, and antibiotics to prevent rebleeding.
Perforated Gastric ULCER
Peptic ulcer disease is caused by acid-pepsin aggression and most commonly affects the duodenum. Helicobacter pylori infection, smoking, NSAIDs, and stress are major risk factors. Patients typically experience episodic epigastric pain relieved by food or antacids. Perforated ulcers present suddenly with generalized abdominal pain and peritonitis. Diagnosis is usually made through chest x-rays showing free air or CT scans detecting free air or fluid. Complications include peritonitis, infection, hypotension, and respiratory failure. Surgical treatments include omental patch, vagotomy, and antrectomy, but carry risks of recurrence or side effects.
Bohomolets 4th year Complications of PUD
The document discusses complications of peptic ulcers, including perforation, hemorrhage, stenosis, and malignization. Perforation is the most common complication and can be difficult to diagnose, particularly in elderly patients or those on steroids. Treatment for perforated ulcers typically involves surgical closure of the perforation along with washing of the abdominal cavity and antibiotics. While laparoscopic repair is possible, open surgery is usually quicker and more effective at washing out stomach contents. Surgeons must also consider whether to add an ulcer-curing procedure like vagotomy or partial gastrectomy. Hemorrhage from peptic ulcers is also potentially lethal, with a mortality rate of 5-10%, and treatment involves resusc
Appendicitis treatment / surgery
Acute appendicitis is fairly common disease.
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Small bowel obstruction and Intestinal Fistulas
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UGIB - ppt 2023.pptx
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, classification, epidemiology, clinical features, diagnostic evaluation, and management. Some key points:
1. UGIB is more common than lower GI bleeding, with a reported incidence of 170 patients per 100,000 population per year. The most common cause is peptic ulcer disease (40% of cases).
2. Risk of rebleeding is higher in patients on antiplatelet therapy and those with recurrent bleeding within 48-72 hours. Mortality is 5-10% for severe UGIB.
3. Diagnostic evaluation includes endoscopy within 24 hours to identify the source of bleeding, as well as
Blunt trauma abdomen
- Blunt abdominal trauma is common in children and can cause significant morbidity and mortality if not recognized.
- The abdomen is more vulnerable in children due to relatively larger and more exposed solid organs as well as less muscle protection.
- A thorough physical exam, focused ultrasound (FAST), and CT scan are used to evaluate for injuries like lacerations to the liver, spleen, and kidneys.
- Most solid organ injuries can be managed non-operatively if the patient is hemodynamically stable, but laparotomy may be needed for severe injuries or instability. Grading systems help determine appropriate treatment for injuries.
Ugibllding
Upper gastrointestinal bleeding in children can be caused by variceal sources such as portal hypertension or non-variceal sources like ulcers. Initial management involves hemodynamic resuscitation and endoscopy to identify the source of bleeding. For variceal bleeding, pharmacologic therapy with vasoactive drugs and endoscopic variceal ligation or sclerotherapy can help stop bleeding. Surgical options are considered if conservative measures fail. Prognosis is poorer if the bleeding site cannot be identified, coagulation disorders are present, or significant blood loss occurs without intervention.
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Obscure GI Bleeding
- 1. PHONGTHORN TUNTIVARARUT POLICE GENERAL HOSPITAL, THAILAND
- 2. Obscure GI Bleeding Bleeding from the small intestine remains a relatively uncommon event ~5–10% of all patients presenting with GI bleeding Up to 90% of lesions responsible for GI bleeding are within the reach EGD and colonoscopy Am J Gastroenterol 2015; 110:1265–1287
- 3. Obscure GI Bleeding Small Bowel Bleeding Which one??
- 4. Obscure GI Bleeding Overt obscure bleeding refers to the presence of hematemesis, melena, or hematochezia Occult obscure bleeding occurs in the patients with positive fecal occult blood test with or without iron- deficiency anemia Schwartz's Principles of Surgery, 10ed
- 5. Common causes of small bowel bleeding Under age 40 years Inflammatory bowel disease Dieulafoy’s lesions Neoplasm Meckel’s diverticulum Polyposis syndrome Over age 40 years Angiodysplasia Dieulafoy’s lesions Neoplasm NSAID ulcers Am J Gastroenterol 2015; 110:1265–1287
- 6. Rare causes of small bowel bleeding Henoch-Schoenlein purpura Small bowel varices in patient with portal HT Amyloidosis Peutz-Jeghers syndrome Kaposi’s sarcoma in HIV patient Hemobilia Aorto-enteric fistula Am J Gastroenterol 2015; 110:1265–1287
- 7. Management of OGIB Initial assessment and resuscitation Localization of the bleeding point Definitive treatment Medication Endoscopic Intervention Surgery
- 8. Bleeding localization Second-look endoscopy or Repeated of EGD and Colonoscopy are recommended Missing lesion can be found ranging from 2 to 25% in repeated EGD and 6 to 23% on repeated colonoscopy Am J Gastroenterol 2015; 110:1265–1287
- 9. EGD and Colonoscopy During the colonoscopy, every effort should be made to intubate the terminal ileum Instead of repeating EGD, a push enteroscopy may be performed to examine the distal duodenum and proximal jejunum Schwartz's Principles of Surgery, 10ed
- 10. Push enteroscopy Push enteroscopy : Performed with a long endoscope such as a pediatric colonoscope or commercial scope Length of the scope is around 250 cm Commercial push enteroscope : 70 cm from ligament of treitz Colonoscopy : 45-60 cm distal to ligament of treitz Diagnostic yield : 3-70% Am J Gastroenterol 2015; 110:1265–1287
- 11. Subacute ongoing small bowel bleeding Massive small bowel bleeding Am J Gastroenterol 2015; 110:1265–1287
- 12. Am J Gastroenterol 2015; 110:1265–1287
- 13. Schwartz's Principles of Surgery, 10ed
- 14. Video Capsule Endoscopy (VCE) First clinical use in US in 2001 Capsule 26x11 mm with frame rate of 2 frames/sec Evaluation of the entire small bowel in 79-90% of patients Diagnostic yield in small bowel bleeding : 38-83% Duration of bleeding, time from bleeding, bleeding amount World J Gastroenterol 2007 December 14; 13(46): 6140-6149
- 15. VCE limitation Diagnostic tool Inability to control its movement Localization difficulty Miss duodenal lesion due to rapid transit False negative rate : 10-36% Cannot exclude SB lesion if negative Capsule retention Am J Gastroenterol 2015; 110:1265–1287
- 17. Deep Enteroscopy
- 18. Deep Enteroscopy First described in 2001 by Yamamoto Both diagnostic and therapeutic tool Diagnostic yield DBE : 60-80% SBE : 33% Complication : ileus, perforation (overall 1.2%) Am J Gastroenterol 2015; 110:1265–1287
- 20. Am J Gastroenterol 2015; 110:1265–1287
Editor's Notes
- In the past, if no source of bleeding was found after an upper and lower endoscopic evaluation, it is called “Obscure GI Bleeding”
- Prevalence : Vascular lesion 24% VS Inflammatory (crohn)16-18% VS Mass 11% Asian พบ neoplastic มากกว่า western ที่พบ angiodysplasia ดูจากการซักประวัติ พอบอกได้ Schwartz Angiodysplasia 75% Neoplasm 10% Meckel in children <30 yr
- ประวัติจะ guide ให้ ว่าคิดถึงอะไร
- ครั้งแรกอาจจะมีเลือดเยอะ
- intubate the terminal ileum to visualize the ileal mucosa and to inspect for blood coming from a more proximal location
- Video capsule endoscopy CT enterography
- Non-invasive ปัจจัยที่ทำให้ yield เพิ่ม ตรงไปตรงมา
- Miss duodenal lesion due to rapid transit ใส่ capsule 2 อัน ช่วย improve ได้ 60%
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