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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 523 records · Page 29Linked to original sources
PubMed1996

Upper gastrointestinal hemorrhage clinical--guideline determining the optimal hospital length of stay.

PURPOSE: Physicians lack objective outcome data to define the medically appropriate length of stay (LOS) for patients hospitalized with acute upper gastrointestinal hemorrhage (UGIH), resulting in wide variations in resource utilization and quality of care. A clinical practice guideline with the ability to assign relative risk for adverse events is proposed. METHODS: A comprehensive scoring system was derived from the literature by using four variables; hemodynamics, time from bleeding, comorbidity, and esophagoduodenoscopy findings. The discriminatory ability, potential safety, and impact on resource utilization of the clinical practice guideline was measured in a retrospective, observational study. RESULTS: Seventy percent of UGIH patients (349 of 500) achieved low-risk status according to the guideline, and, were therefore potentially suitable for early discharge from the hospital. If low-risk patients were discharged based upon the guideline, mean (+/- SD) hospital LOS would have been decreased from 4.8 +/- 2.4 days to 2.7 +/- 1.4 days; mean reduction was 2.1 bed-days per patient (95% CI 1.8 to 2.3, P <0.001). LOS would have increased in 4% of cases. Adopting the guideline's recommendation of early discharge would have resulted in a 0.6% (95% CI 0.07 to 2.1) complication rate, with no worsening of quality of care, as judged by implicit review. CONCLUSIONS: The proposed clinical practice guideline may safely reduce hospital LOS for selected low-risk patients with acute UGIH. Moreover, it also may reduce premature discharge of high-risk patients prone to life-threatening events.

Acute Disease↗
PubMed1995

Upper gastrointestinal hemorrhage associated with cutaneous application of diclofenac gel.

We present four cases of upper gastrointestinal hemorrhage associated with the cutaneous application of diclofenac (Voltaren Emulgel). The patients' ages ranged from 24 to 85 yr. Three of the patients had used the medication three times daily for at least 2 wk before the onset of bleeding. In two cases, the treatment was indicated for backache which, retrospectively, was attributable to a peptic ulcer. In those two patients, the hemorrhage was massive, requiring blood transfusions. Because systemic absorption of nonsteroidal anti-inflammatory drugs from topical formulations has been documented, caution should be exercised when prescribing these formulations to patients with a history of peptic ulcer.

Administration, Cutaneous↗
PubMed1988

Massive gastrointestinal hemorrhage caused by rupture of a jejunal branch artery aneurysm.

Aneurysms located in the arterial tree that directly supplies the alimentary tract account for a small percentage of all aneurysms. Jejunal branch artery aneurysms are an uncommon component of this group, and gastrointestinal hemorrhage from such an aneurysm has rarely been described. We report a case of a jejunal branch artery aneurysm appearing as sudden and massive gastrointestinal bleeding in a 28-year-old man. Diagnosis was made by selective superior mesenteric artery angiography, and the patient underwent successful segmental resection of the involved area of jejunum. The pertinent literature is reviewed.

Adult↗
PubMed1991

[Gastrointestinal hemorrhage after operations for perforated gastroduodenal ulcers].

On the basis of clinical observation over 521 patients who underwent operations in the clinic for perforating gastric and duodenal ulcer, the authors determined the frequency of massive gastrointestinal hemorrhage (3.2%) in the early postoperative period and the mortality rate in this complication. It is shown that the performance of radical surgical interventions instead of simple closure of the perforating ulcer with sutures, in the absence of life-threatening concomitant diseases and the terminal phase of peritonitis, may improve the results of operative management of this disease.

Duodenal Ulcer↗