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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 307 records · Page 17Linked to original sources
PubMed1996

Investigation of upper gastrointestinal hemorrhage in chronic renal failure.

The role of specific pathological findings in the upper gastrointestinal tract in chronic renal failure remains uncertain. Most of the studies were conducted in the West, and the number of subjects was small. We have tried to look at that problem in Taiwan. Endoscopy to evaluate the source of upper gastrointestinal hemorrhage was performed in 698 patients over a 37-month period; that represents 4.4% of all patients undergoing upper gastrointestinal endoscopy for miscellaneous reasons in that time span. Fifty-eight patients (8.3%) who had been hemodialyzed for chronic renal failure were selected, as were 640 control patients who did not have renal failure. Patients with renal transplant were not included. Endoscopic diagnoses, contributing factors of bleeding, and the course and outcome of the hospitalization were analyzed. chi 2 Test with or without Yates' correction and Student's t test were used as appropriate. Erosive gastritis was the most frequent source of bleeding in patients with chronic renal failure. Erosive gastritis (p < 0.005), erosive esophagitis (p < 0.001), and esophageal ulcer (p < 0.005) were significantly more common causes of bleeding in the renal failure population than in the group without renal failure. The two groups did not differ significantly (p > 0.05) in smoking, heavy alcohol intake, or use of ulcerogenic medications. The age was older (64.1 +/- 11.4 vs. 55.7 +/- 16.2 years) and the mortality rate higher (13% vs. 2%) in patients with renal failure than in those without. The differential diagnoses of upper gastrointestinal bleeding sites differ in patients with and without chronic renal failure; they are diverse. However, erosive gastritis, rather than gastric ulcer or duodenal ulcer, is the most common cause in the patients with renal failure. The mortality rate is significantly higher in these patients than in the general population.

Acute Disease↗
PubMed1992

[Gastrointestinal hemorrhage from a duodenal diverticulum].

Duodenal diverticuli are often asymptomatic and are occasionally found during the course of X-ray tests or autopsy. They are sometimes manifested in the form of symptoms related to a complication (hemorrhage, perforation, occlusion). The paper reports a case of gastrointestinal hemorrhage caused by a duodenal diverticulum which was then successfully operated. The Authors affirm that in these cases the resection of the portion of the duodenum with the diverticulum (provided the papilla is not affected) is preferable to direct hemostasis or duodenocephalopancreatectomy.

Aged↗
PubMed2002

Severe anemia after gastrointestinal hemorrhage in a Jehovah's Witness: new treatment strategies.

OBJECTIVE: Management of severe anemia in a critically ill Jehovah's Witness is challenging. In the past, conservative therapy was the only option available to the practitioner. Recently, new interventional treatment strategies have become available, including human and bovine hemoglobin substitutes and high-dose recombinant human erythropoietin. DESIGN: Case report. SETTING: Intensive care unit in a quaternary care center. PATIENT: A patient with severe, life-threatening anemia caused by gastrointestinal hemorrhage who refused all blood products on religious grounds. INTERVENTION: Bovine hemoglobin substitute and high-dose recombinant human erythropoietin. CASE STUDY: A 50-yr-old Jehovah's Witness presented with massive upper gastrointestinal hemorrhage; initial hemoglobin was 3.5 g/dL. Endoscopy revealed a prepyloric ulcer, and hemorrhage control was achieved by epinephrine injections into the peri-ulcer mucosa. Despite control of hemorrhage, the patient became hemodynamically unstable. A total of 7 units of a bovine hemoglobin-based oxygen carrying compound (HBOC-201) was administered to enhance the patient's oxygen delivery. High-dose recombinant human erythropoietin was administered daily (500 units/kg). Hemoglobin levels were initially maintained and then slowly increased to a maximum of 7.6 g/dL on day 24 of therapy. CONCLUSION: This case demonstrates that the concurrent administration of hemoglobin-based oxygen carriers and recombinant human erythropoietin in severe, life-threatening anemia (hemoglobin, 3.5 g/dL) was associated with patient survival and a significant increase in hemoglobin to 7.6 g/dL, without the administration of allogeneic blood. Hemoglobin-based oxygen carriers can adequately serve as initial therapy to maintain tissue oxygen delivery while awaiting the maximal effect of recombinant erythropoietin on bone marrow red blood cell production. High-dose recombinant human erythropoietin offers these patients the best chance for normalization of hematocrit and survival in the long term.

Anemia↗
PubMed1999

Risk factors for rebleeding and mortality from acute upper gastrointestinal hemorrhage in human immunodeficiency virus infection.

OBJECTIVES: In the general population, acute upper gastrointestinal hemorrhage (UGIH) is a common problem that results in significant morbidity and mortality. The aim of this study was to determine the etiology, clinical outcome, and risk factors for rebleeding and mortality in a large cohort of human immunodeficiency virus (HIV)-infected patients with acute UGIH. METHODS: We reviewed the medical records of consecutive HIV-infected patients with acute UGIH who were referred for an endoscopic evaluation from January 1992 through January 1997 at Bellevue Hospital Center. RESULTS: During the 5-yr study period, 297 HIV-infected patients with acute UGIH were evaluated by endoscopy. Gastroduodenal ulcers (25.6%), esophageal ulcers (21.5%), and Kaposi's sarcoma (19.2%) were the three most common causes of acute UGIH. Fifteen percent of patients rebled within 30 days and independent predictors of rebleeding included a CD4 count of <200 cells/mm3, inpatient status, a hemoglobin of <8 g/dl, major stigmata of hemorrhage, and lymphoma. The 30-day mortality from UGIH was 11.4% and a hemoglobin of <8 g/dl, a platelet count of <100,000/mm3, major stigmata of hemorrhage, rebleeding within 30 days, and lymphoma were independent predictors of mortality. The introduction of protease inhibitors in December 1995 resulted in a reduction in 30-day mortality from 13.5% to 4.4% (p = 0.04) without affecting the etiology of UGIH or the incidence of rebleeding. CONCLUSIONS: Acute UGIH in HIV-infected patients is most commonly due to gastroduodenal ulcers, esophageal ulcers, and Kaposi's sarcoma. In this patient population, the introduction of protease inhibitors has had a positive impact on the outcome of UGIH.

Acute Disease↗
PubMed1995

[Angiography for the management of poorly controlled gastrointestinal hemorrhage--20 cases clinical observation].

Diagnostic and therapeutic angiography has demonstrated an important role in gastrointestinal hemorrhage. During the past 2 years, we performed angiography in the management of 20 patients with uncontrolled gastrointestinal bleeding. Conservative management including medication and transfusion would not appear to suffice in these patients and most patients had been evaluated to have a high operative risk in our series. Ten of the 20 patients had renal dysfunction (creatinine > 1.7 mg/dl) before angiography. The role of angiography in the management of patients with renal dysfunction remains controversial because angiography is likely to produce acute renal failure. We performed angiography to stop bleeding in these patients with renal dysfunction because they could die of blood loss. In our 20 cases, bleeding sites were identified in 14 patients. The detection rate was 70%. Thirteen of the 14 with the use of either vasopressin infusion or arterial embolization showed complete cessation of bleeding in 10 patients. Three cases failed to be controlled. One received an operation after a bleeding site was located by angiography. In our study, sepsis with renal failure was the leading cause of mortality (6 cases). Ten patients with pre-existing renal dysfunction had angiography performed and only one showed abrupt elevation of creatinine levels after angiography. He also developed sepsis. Deterioration of renal function was possibly due to angiography or more likely due to sepsis and hypovolemia. Six patients died of sepsis after angiography although 4 of these patients showed cessation of bleeding. Four cases with pre-existing renal dysfunction and without evidence of infection survived after angiographic management.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗