Gastrointestinal Emergencies

2019 ◽  
pp. 43-70
Author(s):  
Sukhjit Dhillon ◽  
James McCue ◽  
Steven Riccoboni ◽  
Caleb Sunde
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Mesenteric Ischemia ◽  
Gastrointestinal Disorders ◽  
Age And Gender ◽  
Duration Of Symptoms ◽  
Bacterial Peritonitis ◽  
Bilirubin Encephalopathy ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
And Gender

Gastrointestinal disorders and emergencies are one of the most common presentations to an emergency department (ED). Symptoms frequently seen in the ED include abdominal pain, nausea, vomiting, diarrhea, and fever. The differential diagnosis changes depending on the age and gender of the patient, duration of symptoms, the systemic effects, recent travel or exposures, and the description of the symptoms. Life-threatening emergencies include abdominal aortic aneurysm, mesenteric ischemia, foreign body ingestion, gastrointestinal bleeding, acute pancreatitis, spontaneous bacterial peritonitis, aortoenteric fistula, and acute bilirubin encephalopathy, among others. It is the emergency physician’s job to recognize these life-threatening conditions of the gastrointestinal tract and start treatment.

scholarly journals The bowel and beyond: extracolonic findings from CT colonography

2021 ◽  
Author(s):  
Gerard Lambe ◽  
Peter Hughes ◽  
Louise Rice ◽  
Caoimhe McDonnell ◽  
Mark Murphy ◽  
...  
Keyword(s):  
Ct Colonography ◽  
Surgical Intervention ◽  
Potential Significance ◽  
Age And Gender ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Extracolonic Findings ◽  
The Difference ◽  
Clinically Significant ◽  
And Gender

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.

Effect of Proton Pump Inhibitors on Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Tsung-Hsing Hung ◽  
Chih-Wei Tseng ◽  
Hsing-Feng Lee ◽  
Chih-Chun Tsai ◽  
Chen-Chi Tsai
Keyword(s):  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Cox Regression ◽  
Bacterial Peritonitis ◽  
Hazard Ratios ◽  
Short Term Mortality ◽  
Life Threatening ◽  
Taiwan National Health Insurance

Introduction and aim. Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with cirrhosis. However, it is unknown whether patients with SBP and cirrhosis who do not have active gastrointestinal bleeding have a poorer prognosis if treated with proton pump inhibitors (PPI). Material and methods. We used the Taiwan National Health Insurance Database to identify 858 patients with SBP and cirrhosis who were administered PPIs and hospitalized between January 1, 2010, and December 31, 2013. One-to-two propensity score matching was performed to select a comparison group based on age, gender, and comorbidities. All patients obtained follow-up for 1 year. Results: The overall 30-day, 90-day, and 1-year mortality was 27.9%, 49.0%, and 73.7%, respectively, in the PPI group and 25.6%, 43.8%, and 67.2%, respectively, in the non-PPI group. After adjusting the Cox regression model for age, gender, and comorbidities, the hazard ratios for PPIs regarding 30-day, 30- to 90-day, and 90-day to 1-year mortality were 1.074 (95% CI 0.917-1.257, P = 0.377), 1.390 (95% CI 1.154-1.673, P = 0.001), and 1.297 (95% CI 1.099-1.531, P = 0.002), respectively. Conclusions: PPIs did not increase the short-term mortality of patients with SBP and cirrosis who did not have active gastrointestinal bleeding, but PPIs increased the long-term mortality risk. For these patients, physicians should discontinue PPIs as early as possible.

Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal Syndrome

2015 ◽  
Author(s):  
Fredric D. Gordon
Keyword(s):  
Web Sites ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Treatment Options ◽  
Screening Tests ◽  
Refractory Ascites ◽  
Bacterial Peritonitis ◽  
Life Threatening ◽  
Associated Conditions ◽  
Primary Focus

Ascites, a common occurrence in cirrhotic patients with portal hypertension, is the pathologic accumulation of fluid in the peritoneum. Associated conditions are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP occurs in 30% of patients with ascites and carries a 20% mortality, most often due to the severity of the underlying cirrhosis. HRS involves life-threatening sequela of refractory ascites with limited treatment options; a review that focuses exclusively on this disease can be found elsewhere in this section. The development of these diseases is a poor prognostic feature, and referral for liver transplantation should be a consideration. This review examines ascites, SBP, and HRS and their relation to each other. The primary focus is ascites, addressing its epidemiology, pathophysiology, diagnosis, differential diagnosis, and management. Figures show theories of ascites formation and pathophysiology of HPS. Tables list screening tests on ascitic fluid, serum ascites–albumin gradient, drugs and agents to avoid in patients with ascites, diagnostic criteria for HPS, and clinical features of type 1 HPS. Also included are two recommended, pertinent Web sites for those who wish to learn more about ascites, SBP, and HPS. This review contains 2 highly rendered figures, 5 tables, and 73 references.

Abstract 100: Clinical impact of United States Preventive Services Task Force screening recommendations for abdominal aortic aneurysm: Analysis of Nationwide Inpatient Sample data

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Sourabh Aggarwal ◽  
Devin Malik ◽  
Mark Schauer
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Task Force ◽  
Clinical Impact ◽  
P Value ◽  
Age Group ◽  
Age And Gender ◽  
Abdominal Aortic ◽  
And Gender

Introduction: An abdominal aortic aneurysm (AAA) is defined when infra-renal aortic diameter is at least 3.0 cm. The United States Preventive Services Task Force recommended in 2005 that all men between the ages of 65 to 75 years who have ever smoked should be screened once for AAA by abdominal ultrasonography. However, the clinical impact of these recommendations are unknown. Methods: We queried Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) data for AAA and AAA rupture using ICD9 codes 441.4 and 441.3 respectively. The NIS represents 20% of all hospitals data in the US. All the data was extracted for years 2000-2010. Total hospitalizations and in-hospital mortality for pre-screening years (2000-2004) was compared with post-screening years (2006-2010) for both AAA and AAA rupture. Results: A total of 527,801 hospitalizations secondary to AAA and AAA rupture were analyzed for the study period. Hospitalizations from AAA decreased from 61.72 to 58.77 per 10,000 total hospitalizations with in-hospital mortality decreasing from 3.5% to 2.12% (p value <0.001). On sub-analysis, the decrease in hospitalizations was significant in 65-84 age group (77.19 to 74.54 per 100 AAA admissions, p <0.001), with significant increase in 84+ age group (6.37 to 8.6 per 100 AAA admissions, p<0.001) and non-significant increase in 45-64 age group (16.16 to 16.51 per 100 AAA admissions, p value >0.05). Decrease in mortality was uniform in all age and gender sub-groups. The hospitalizations from AAA rupture decreased from 9.51 to 7.03 per 10,000 total hospitalizations (p<0.001) with mortality decreasing from 49.9% to 44.6% (p value <0.001). On sub-analysis decrease in hospitalizations was reciprocated in 65-84 age group (70.08 to 64.94 per 100 AAA rupture admissions, p value <0.001) and males (73.23 to 71.7 per 100 AAA rupture admissions, p value <0.001). However, hospitalizations from AAA rupture increased in age group 45-64 (14.41 to 15.43 per 100 AAA rupture admissions, p value <0.001), age 84+ (15.21 to 19.2 per 100 AAA rupture admissions, p value < 0.001) and females (26.28 to 28.28 per 100 AAA rupture admissions, p value <0.001). In-hospital mortality from AAA rupture decreased in all age and gender sub-groups independently. Conclusion: Our study reveals that post screening recommendations, hospitalizations for AAA decreased significantly in the age group 65-84 years. Also, hospitalizations from AAA rupture decreased in males and age group 65-84, with increase in other age sub groups (45-64 and 84+) and females. Thus, screening recommendations have resulted in decreased hospitalizations in specified age-gender subgroup likely from early recognition and better control of risk factors as outpatient. Our study also makes case to consider extension of recommendations to include other susceptible groups though prospective studies might be needed to support the data.

Empirical Analysis of Clinical Evaluations on Children Involved in the Child Protection System: The Role of Age and Gender

2000 ◽  
Author(s):  
Erika Felix ◽  
Anjali T. Naik-Polan ◽  
Christine Sloss ◽  
Lashaunda Poindexter ◽  
Karen S. Budd
Keyword(s):  
Empirical Analysis ◽  
Child Protection ◽  
Protection System ◽  
Age And Gender ◽  
Clinical Evaluations ◽  
And Gender
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