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Results for “HEMORRHAGE, GASTROINTESTINAL”

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PubMed2002

Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage.

The treatment of arterial gastrointestinal hemorrhage continues to evolve. Currently, most interventional radiologists approach bleeding both in the upper and lower gastrointestinal tract with intention to treat. Embolization has replaced local vasoconstrictive therapy as the catheter-based treatment of choice in many hospitals. Coaxial microcatheters have simplified embolotherapy and enabled lower gastrointestinal bleeding to be treated safely and effectively.

Acute Disease↗
PubMed1977

Gastrointestinal hemorrhage in patients in a respiratory intensive care unit.

Significant gastrointestinal hemorrhage occurred in 20% (20) of the patients in a respiratory intensive care unit. Risk factors significantly associated with the development of gastrointestinal hemorrhage included (1) the principal respiratory diagnosis of adult respiratory distress syndrome; (2) increasing numbers of days on a ventilator, days in the respiratory intensive care unit, and total days of hospitalization; and (3) the development of thrombocytopenia. Factors not associated with an increased risk of gastrointestinal hemorrhage were the age and sex of the patient, the respiratory diagnosis of chronic obstructive pulmonary disease, and the use of therapy with either heparin or corticosteroids. Routine prophylactic administration of antacids was associated with a decreased incidence of hemorrhage. The mortality of bleeders was significantly greater than that of nonbleeders.

Antacids↗
PubMed1994

Angiographic diagnosis and management of gastrointestinal hemorrhage. Current concepts.

Gastrointestinal bleeding is now seen less often by the angiographer than in the past, owing to advances in pharmacology, endoscopy, and nuclear medicine. When patients with gastrointestinal bleeding are referred, it is often for therapy as well as diagnosis. Therapeutic options include infusion of vasoconstrictors and selective embolization, which is usually faster and more definitive. Depending on the agent used, embolization is generally quite safe and effective. The risk of ischemia is significant only in the colon or when collateral pathways have been previously interrupted. The management of variceal bleeding has changed significantly due to the advent of TIPS and the increasing availability of liver transplantation.

Angiography↗
PubMed1998

[Gastrointestinal hemorrhages in children].

Gastrointestinal bleeding is not rare in paediatric practice. Always impressive to the surrounding family, they reveal an underlying affection (portal cavernous haemangioma, ulcer) or complicate a progressing disease (oesophagitis, varix). Gastrointestinal endoscopy should be made rapidly in a paediatric setting. The main causes are: before 2 years of age and over 7 years, peptic oesophagitis; from 2 to 7 years, acute lesions of the gastroduodenal mucous membrane and ulcers. Lower tract bleeding (melaena or rectal bleeding) is mainly due to anal fissures, polyps, severe inflammatory colitis and enterocolitis.

Child↗
PubMed1977

Upper gastrointestinal hemorrhage--diagnosis and management.

THE CURRENT MANAGEMENT OF A PATIENT WITH UPPER GASTROINTESTINAL HEMORRHAGE INVOLVES THREE STEPS: initial correction of unstable hemodynamics, obtaining the specific diagnosis of the lesion responsible for gastrointestinal blood loss, and therapy directed at the specific bleeding lesion. The current approach to upper gastrointestinal hemorrhage is carrying out upper gastrointestinal endoscopy following stabilization of the patient. Although improved morbidity and mortality statistics have been slow to appear, the use of endoscopy permits appropriate therapy directed at the specific lesion. Specific therapeutic measures have been outlined for seven common causes of upper gastrointestinal hemorrhage. The advent of therapeutic endoscopy promises to bring further advances in therapy in the near future.

Esophageal and Gastric Varices↗
PubMed1980

Azotemia in upper gastrointestinal hemorrhage. A review.

The cause of the azotemia associated with gastrointestinal hemorrhage has been controversial but review of the literature reveals consistent findings. If extraneous, complicating factors are excluded, the azotemia produced with blood ingestion does not reproduce that seen with gastrointestinal hemorrhage. Azotemia with blood ingestion alone demonstrates a mild peak and usually lasts less than 24 hours, whereas that seen clinically is both higher and longer and a manifestation of blood ingestion plus the renal effects of hypovolemia. The hypovolemia contributes quantitatively more than the digestion of blood and is the sole determinant of azotemia after 24 hours. Consequently, azotemia which persists beyond this time indicates either continuation of bleeding, continuation of hypovolemia insult or intrinsic renal disease. Persistent azotemia following gastrointestinal hemorrhage is an indication for re-evaluation of fluid management.

Animals↗
PubMed1983

Endoscopic hemostasis of gastrointestinal hemorrhage by local application of absolute ethanol: a clinical study.

The procedure of endoscopic hemostasis with topical injection of absolute ethanol has been developed and applied since 1975 for the control of postoperative hemorrhage associated with diathermic polypectomy. Since June 1979, upper gastrointestinal hemorrhages other than varices have also been subjected to this procedure. This method is based on the principle of dehydration and fixation of the tissue with absolute ethanol. In this procedure, the bleeding vasculatures are dehydrated and fixed with consequent vasoconstriction and necrosis of the vascular wall including its endothelial lining, thereby thrombogenesis and hemostasis are facilitated. The troubled blood vessels fixed in vivo are disintegrated and disappeared. Rebleeding from the ulcer has been extremely rare with this method since the necrotized tissue seldom defoliates but often constitutes a part of the white coating and protects the base of ulcer. Treatment by this method has been successful in all 23 cases of upper gastrointestinal hemorrhage associated with endoscopic diathermy, and none has developed rebleeding. The hemostasis has also been successful in 51 cases (72 hemorrhagic lesions) with fresh blood clots adhering to the lesion, exposed blood vessels in the lesion or an actively bleeding lesion out of 126 cases referred for emergency endoscopic examination because of upper gastrointestinal hemorrhage during the 3-year period from June 1979 to May 1982. After hemostasis, however, 3 patients received an elective operation and one patient was also operated due to perforation of the gastric wall. Rebleeding occurred in 3 cases more than a week after the hemostasis; one of these was the above-described operated case of perforation. The rebleeding occurred in stress ulcers following surgery for femoral fracture. The other two were at the terminal stage of malignancy and complicated with DIC respectively. Of the patients treated by this method, 8 died by causes other than gastrointestinal hemorrhage. All the rest of 39 cases attained cure of ulcer by the non-surgical treatment alone.

Adult↗
PubMed1996

Gastrointestinal hemorrhage after acute stroke.

BACKGROUND AND PURPOSE: Although patients with critical illness or acute head injury are known to be at risk of gastrointestinal hemorrhage, there is little information concerning acute stroke. We sought to record the frequency, possible causes, and course of gastrointestinal hemorrhage in a cohort of hospitalized stroke patients. METHODS: During a 36-month period we prospectively identified 613 strokes (excluding subarachnoid hemorrhage). We then retrieved the case notes, and a single observer reviewed all available records (n=607), noting any episodes of gastrointestinal hemorrhage together with details concerning the course, possible precipitating+ factors, management, and outcome. RESULTS: Eighteen patients (3%) experienced a gastrointestinal hemorrhage, half of which were severe. These patients were older and had suffered more severe strokes than those without any gastrointestinal bleeding. The source was identified in 5 patients; 2 had gastric ulceration, 2 duodenal ulceration, and the remaining one had esophageal/duodenal ulceration. In 17 patients, there was a potential risk factor for hemorrhage, although the odds ratios comparing the use of antithrombotic drugs in the hemorrhage and nonhemorrhage groups did not achieve statistical significance. Death during the acute admission period was more common in the 18 hemorrhage patients (odds ratio, 4.6; 95% confidence interval, 1.7 to 13.2; two-tailed P=.002, Fisher's exact test); of the 10 who died, gastrointestinal hemorrhage appeared to have been a contributing factor in 3. CONCLUSIONS: Our study provides a reasonably accurate estimate of the frequency of gastrointestinal hemorrhage after acute stroke. The higher frequency found in our study than the previously published data is probably due to study methodology. Older patients with more severe strokes may be at increased risk of this complication, and it may adversely affect outcome.

Age Factors↗
PubMed2003

[Acute upper gastrointestinal hemorrhage. Diagnosis and management].

Upper gastrointestinal hemorrhage calls for a team approach. Early endotracheal intubation of unconscious patients helps to prevent aspiration. Erythromycin i.v. 20 min. before emergency endoscopy improves the diagnostic yield. Patients without increased risk of rebleeding may be treated on an outpatient basis. Band ligation is the gold standard for acute variceal bleeding. Terlipressin, somatostatin and octreotide are equally effective but require additional measures for prevention of late recurrence. Somatostatin and analogues used as adjunct to ligation slightly reduce the risk of rebleeding but not of death. Three to seven days of prophylactic antibiotics decrease the risk of uncontrolled or recurrent bleeding. Therapeutic failures are rescued by transjugular intrahepatic portosystemic shunting (TIPS). Patients with nonvaricose bleeding should only be treated when active hemorrhage or a "visible vessel" is found. First line treatment is endoscopic injection of diluted adrenalin or isotonic saline. Thermal coagulation is an alternative. Tissue-destructing sclerosants should be avoided. Clipping and injection of fibrin glue are second and third line measures. Proton pump inhibitors improve endoscopic hemostasis, however, it is unclear whether high i.v. doses are required. H. pylori must be eradicated to prevent late recurrence. Rebleeding is treated endoscopically with angiographic intervention or surgery as rescue measures.

Acute Disease↗
PubMed2005

Myocardial infarction and cardiac complications in emergency department patients admitted to the intensive care unit with gastrointestinal hemorrhage.

Patients admitted with significant gastrointestinal hemorrhage (GIH) often experience in-hospital cardiac complications. This retrospective study examined 68 patients admitted from the Emergency Department to the Intensive Care Unit (ICU) over a 1-year period. The patients were 75% Caucasian, 60% male, with a mean age of 57 +/- 19 years. Medical co-morbidity was noted in 70%, and 54% of patients had a history of significant alcohol use. A systolic blood pressure < 100 mm Hg was present in 26%, hemoglobin < 7 mg/dL in 32%, and three patients (4%) expired. Death, acute myocardial infarction or other cardiac complications were noted in 32% of patients. Patients older than 60 years were three times more likely to have a complicated course than were younger patients, and those with a co-morbidity were 14.8 times more likely. Patients with a history of significant alcohol use were 31% less likely to have an inpatient complication than those without such a history. Regression analysis supported the protective effect of a history of significant alcohol use and also demonstrated that a history of peptic ulcer disease was predictive of inpatient complications. Older GIH patients and those with co-morbidities may benefit from ICU disposition given their greater risk. Younger patients presenting with hematemesis and a history of significant alcohol use tended to have fewer complications such that it may be possible to manage these patients outside of the ICU if hemodynamically stable.

Age Factors↗
PubMed1979

Selective embolization for control of gastrointestinal hemorrhage.

Transcatheter embolization using Gelfoam plugs or autologous clot is an alternative or adjunct to the conventional management of gastrointestinal hemorrhage. During a 12 month period we successfully treated 10 patients who had massive gastrointestinal hemorrhage with selective embolization; 6 patients had upper gastrointestinal hemorrhage and 4 had bleeding from the colon. Most of these patients were critically ill and were poor surgical candidates. Hemorrhage was controlled by selective catheterization of the bleeding vessel, followed by injection of Gelfoam pledgets. Since the procedure was accomplished with ease and prolonged hemostasis obtained, we recommend it for gastrointestinal hemorrhage, especially in patients who are poor surgical risks or are unresponsive to vasopressin infusion, or both. Operative intervention for the primary disease could subsequently be performed electively, if necessary, days or weeks after transcatheter embolization.

Adult↗
PubMedDate not supplied

[Postoperative gastrointestinal hemorrhages after pulmonary resections (author's transly].

Postoperative gastrointestinal hemorrhages are a infrequent complication of pulmonary resections. Nevertheless they are threatening seriously patient's life because a critical illness as gastrointestinal hemorrhage in such casses hit patients whose vital functions are compromised from recent thoracic surgery. The pathogenetic questions, as well critical problems of diagnosis and treatment, are discussed on the basis of three observed cases.

Gastrointestinal Hemorrhage↗