Acute lower gastrointestinal bleeding

2013 ◽  
pp. 21-33
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Gastrointestinal Bleeding ◽  
Lower Gastrointestinal Bleeding ◽  
Lower Threshold ◽  
Outpatient Basis ◽  
Gi Bleeding ◽  
Initial Management ◽  
Urgent Surgery ◽  
Co Morbidity ◽  
Lower Gi Bleeding

Lower gastrointestinal bleeding Initial management Admission Definitive investigations Complications of endoscopy Investigations if cause not identified Treatment of specific conditions Co-morbidity and lower gastrointestinal bleeding Non-severe overt lower gastrointestinal bleeding Lower GI bleeding is common but usually of only modest severity. Most can be managed on an outpatient basis, although unwell patients need admission (have a lower threshold for patients with severe co-morbidity). In total, ~35% of significant bleeds require transfusion and 5% urgent surgery (see the ...

scholarly journals Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Tzung-Jiun Tsai ◽  
Wen-Chi Chen ◽  
Yu-Tung Huang ◽  
Yi-Hsin Yang ◽  
I-Che Feng ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Gastroduodenal Ulcer ◽  
Lower Gastrointestinal Bleeding ◽  
Ulcer Bleeding ◽  
Research Database ◽  
Bleeding Tendency ◽  
Gi Bleeding ◽  
Control Subjects ◽  
Lower Gi Bleeding ◽  
And Control

Background. Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding. Results. Dialysis CKD patients (n=574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n=1148) and control subjects (n=1148) (12.9% vs. 3.6% and 2.8%; both P<0.001). Multivariate analysis showed that extreme old age (age≥85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P=0.003). Conclusion. Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.

scholarly journals Arteriovenous Fistula of Superior Mesenteric Artery: An Unusual Cause of an Massive Lower Gastrointestinal Bleeding

2019 ◽  
Vol 104 (9-10) ◽  
pp. 499-501
Author(s):  
Yang Yang ◽  
Qisheng Ran ◽  
Dongfeng Chen
Keyword(s):  
Gastrointestinal Bleeding ◽  
Superior Mesenteric Artery ◽  
Arteriovenous Fistula ◽  
Mesenteric Artery ◽  
Right Hemicolectomy ◽  
Lower Gastrointestinal Bleeding ◽  
Gi Bleeding ◽  
Case Presentation ◽  
Common Causes ◽  
Lower Gi Bleeding

Introduction The most common causes of lower gastrointestinal (GI) hemorrhage are diverticulosis and angiodysplasia. Arteriovenous fistula (AVF) of the intestine is an uncommon cause of GI hemorrhage. Case Presentation Herein, we report a case of an embolization of an AVF originated from the superior mesenteric artery and vein as a cause of acute massive lower GI bleeding. Conclusion The patient underwent a right hemicolectomy and ileotransversostomy.

Lower Gastrointestinal Bleeding

2017 ◽  
Author(s):  
Chasen A Croft ◽  
Frederick Moore
Keyword(s):  
Gastrointestinal Bleeding ◽  
Lower Gastrointestinal Bleeding ◽  
Diagnostic Workup ◽  
High Morbidity ◽  
Gi Bleeding ◽  
Primary Methods ◽  
Push Enteroscopy ◽  
Initial Symptoms ◽  
Life Threatening ◽  
Lower Gi Bleeding

Lower gastrointestinal (GI) hemorrhage is a common clinical condition often encountered by the acute care surgeon. Lower GI bleeding, defined as bleeding distal to the ligament of Treitz, may present with diverse manifestations, from occult bleeding as evidenced only by anemia to massive hemorrhage and exsanguination. Severe, life-threatening hemorrhage may present precipitously with few initial symptoms. As such, the astute surgeon must be able to expeditiously identify patients with acute, massive lower GI bleeding and initiate the appropriate therapeutic algorithm to reduce the high morbidity and mortality associated with this condition. After initial resuscitation, the cause of the hemorrhage must be identified. Identification of the bleeding site often includes a multidisciplinary approach, including practitioners from critical care, gastroenterology, radiology, and surgery. In general, the primary methods to locate the site of hemorrhage include CT and endoscopy. Advances in endoscopic localization have increased both the diagnostic and therapeutic yields of such therapy. Surgical intervention is generally reserved for those patients in whom hemodynamic instability precludes further diagnostic workup or those in whom the source of bleeding cannot be controlled with other modalities. In this review, we discuss the diagnostic workup and therapeutic management of life-threatening lower GI hemorrhage. This review contains 10 figures, 3 tables and 93 references Key words: BLEED criteria, colonic ischemia, colonoscopy, CT angiography, diverticular disease, lower gastrointestinal bleeding, mesenteric arteriography, nuclear scintigraphy, push enteroscopy, video capsule endoscopy

scholarly journals Lower GI Bleeding: An Update on Incidences and Causes

2019 ◽  
Vol 33 (01) ◽  
pp. 028-034
Author(s):  
Titilayo Adegboyega ◽  
David Rivadeneira
Keyword(s):  
Small Intestine ◽  
Gastrointestinal Tract ◽  
Gastrointestinal Bleeding ◽  
Vascular Malformations ◽  
Lower Gastrointestinal Bleeding ◽  
Morbidity And Mortality ◽  
Significant Source ◽  
Gi Bleeding ◽  
Lower Gastrointestinal Tract ◽  
Lower Gi Bleeding

AbstractBleeding from the lower gastrointestinal tract represents a significant source of morbidity and mortality. The colon represents the vast majority of the location of bleeding with only a much smaller incidence occurring in the small intestine. The major causes of lower gastrointestinal bleeding (LGIB) are from diverticulosis, vascular malformations, and cancer. We discuss the incidence and causes of LGIB.

Laparoscopic Small Bowel Resection And Anastmosis For Small Proximal Jejunal Gastrointestinal Stromal Tumor Presented With Acute Massive Lower Gastrointestinal Bleeding: Case report and Literature review

2020 ◽  
Author(s):  
khaled S ahmad ◽  
Mohamed S Essa ◽  
Naif A Alenazi
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Gi Bleeding ◽  
Case Presentation ◽  
Pressure Necrosis ◽  
Lower Gi Bleeding ◽  
Small Intestinal ◽  
Work Up

Abstract Background Gastrointestinal stromal tumors (GISTs) is the most common primary nonepithelial neoplasms of the gastointestinal tract, mostly expressing the KIT protein determined by immunohistochemical staining for the CD117 antigen. Jejunal GISTs represent approximately 10% of all GISTs. Abdominal discomfort is the usual presentation. Jejunal GISTs may present with complications such as intestinal obstruction or hemorrhage. Gastrointestinal bleeding occurs due to pressure necrosis and ulceration of overlying mucosa, and patients who develop significant bleeding may suffer from fatigue and malaise. Small-bowel GISTs are classified based on size, and several guidelines have recommended conservative treatment for small jejunal GISTs (<2 cm).Case presentation In this report, we describe a 35-year-old male, with a jejunal GIST, who presented with an unusual massive lower GI bleeding. After resuscitation extensive work up, he was taken finally for a diagnostic laparoscopy and resection of the mass.Conclusion Small intestinal GISTs are rare and unusual to present with massive lower GI bleeding.

scholarly journals Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Fahad Saeed ◽  
Nikhil Agrawal ◽  
Eugene Greenberg ◽  
Jean L. Holley
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gastrointestinal Bleeding ◽  
Chronic Hemodialysis ◽  
Lower Gastrointestinal Bleeding ◽  
Gi Bleeding ◽  
Common Causes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem.

Successful Control of Massive Gastrointestinal Bleeding Following Umbilical Cord Blood Transplantation (UCBT) by Use of Recombinant Activated Factor VII (rFVIIa) and Octreotide Infusion

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4336-4336
Author(s):  
Satya Prakash Yadav ◽  
Anupam Sachdeva ◽  
Madasu Anjan ◽  
Nita Radhakrishnan ◽  
Sunil Bhat ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Factor Viia ◽  
Fresh Frozen Plasma ◽  
Gi Bleeding ◽  
Blood Products ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Lower Gi Bleeding ◽  
Gi Bleed ◽  
Frozen Plasma

Abstract Post stem cell transplantation (SCT) bleeding is a dreaded complication especially gastrointestinal (GI). Platelet refractoriness is another but rare cause of bleeding post SCT. Use of rFVIIa for bleeding in setting of SCT was tested by Pihusch et al in 100 patients. Despite no overall effect of rFVIIa treatment on primary endpoint, post hoc analysis showed an improvement in the control of bleeding for 80 ug kg rFVIIa vs. standard haemostatic treatment. There were 38 patients with GI bleeding but none with massive bleeding. There are only 8 other case reports of use of rFVIIa for massive lower GI bleeding post allogeneic SCT with only one patient showing partial response and none of the patients surviving. The role of octreotide is less clear in gastrointestinal bleeding unrelated to portal hypertension. Y. Eroglu reported that, the response rate of gastrointestinal bleeding to octreotide in patients without portal hypertension was 50%. We present a 10 month-old female child, who had three episodes of life threatening lower GI bleeding post unrelated UCBT controlled successfully each time by use of rFVIIa and octerotide infusion. Patient underwent an unrelated UCBT for Thalassemia Major with a 4/6 matched cord unit and was conditioned with Busulfan 14 mg/kg, Cyclophosphamide120 mg/kg and Anti- Thymocyte Globulin. Cyclosporine and Methotrexate was given for Graft vs. host Disease prophylaxis. Cell dose infused was 7 × 107 nucleated cell/kg. She failed to engraft and also developed refractory thrombocytopenia. On Day + 48 post UCBT she developed massive lower GI bleed (passing big clots per rectum) with hypotension. Her platelets were 8,000/mm3, Hb of 4.5 gm/dl. Her coagulation parameters were normal. She was given packed cells, platelets (random donor and apheresis), Fresh Frozen Plasma (FFP) and tranexamic acid (250 mg IV 8 hrly). She was also started on injection octreotide infusion (1μg/kg bolus followed by 1μg/kg/hr infusion). Patient continued to have life threatening lower GI bleed (bleeding score-4) with no rise in platelets so a decision was made to administer rFVIIa (once she was repleted with packed cells, platelets and fresh frozen plasma) using the bolus dose of 90 μg/kg IV 3 doses 2 hrly. Autologous marrow was infused with CD34 cell dose 7 million/kg in view of non-engraftment. The bleeding subsided completely (within 6 hrs) after three doses of rFVIIa and the blood pressure normalized. Octreotide infusion was stopped after 12 hrs of bleeding free interval. After a 24 hr bleeding free period on Day +50 post UCBT, patient again bled with hypotension and again required factor VIIa (two doses) along with blood products and octreotide infusion and again showed excellent response. Again on Day+59 post UCBT she had another episode of massive lower GI bleed with hypotension and again required activated factor VIIa (two doses only) along with blood products and octreotide infusion) and bleeding stopped in next 8 hr. There was no further episode of lower GI bleed. No adverse effects due to rFVIIa were observed. She was discharged after 2 weeks with recovery of neutrophills and platelets and continues to be well Day +100 post transplant. Following this case we suggest that rVIIa with octerotide be considered as a mode of additional therapy for life-threatening GI bleeding in the face of severe thrombocytopenia and platelet refractoriness, where platelet transfusions and other haemostatic agents have failed.

Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation

2020 ◽  
Author(s):  
Peter Vibe Rasmussen ◽  
Frederik Dalgaard ◽  
Gunnar Hilmar Gislason ◽  
Axel Brandes ◽  
Søren Paaske Johnsen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Absolute Risk ◽  
Age Groups ◽  
Parametric Estimation ◽  
Gi Bleeding ◽  
Increased Risk ◽  
Lower Gi Bleeding ◽  
The Absolute

Abstract Aims Gastrointestinal bleeding (GI-bleeding) is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) therapy. We sought to investigate to what extent lower GI-bleeding represents the unmasking of an occult colorectal cancer. Methods and results A total of 125 418 Danish AF patients initiating OAC therapy were identified using Danish administrative registers. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risks of colorectal cancer in patients with and without lower GI-bleeding. During a maximum of 3 years of follow-up, we identified 2576 patients with lower GI-bleeding of whom 140 patients were subsequently diagnosed with colorectal cancer within the first year of lower GI-bleeding. In all age groups, we observed high risks of colorectal cancer after lower GI-bleeding. The absolute 1-year risk ranged from 3.7% [95% confidence interval (CI) 2.2–6.2] to 8.1% (95% CI 6.1–10.6) in the age groups ≤65 and 76–80 years of age, respectively. When comparing patients with and without lower GI-bleeding, we found increased risk ratios of colorectal cancer across all age groups with a risk ratio of 24.2 (95% CI 14.5–40.4) and 12.3 (95% CI 7.9–19.0) for the youngest and oldest age group of ≤65 and &gt;85 years, respectively. Conclusion In anticoagulated AF patients, lower GI-bleeding conferred high absolute risks of incident colorectal cancer. Lower GI-bleeding should not be dismissed as a benign consequence of OAC therapy but always examined for a potential underlying malignant cause.

scholarly journals Diagnostic Modalities in Gastrointestinal Bleeding

2020 ◽  
Vol 33 (01) ◽  
pp. 005-009 ◽  
Author(s):  
Daniel L. Feingold ◽  
Emmanouil P. Pappou ◽  
Steven A. Lee-Kong
Keyword(s):  
Computed Tomography ◽  
Gastrointestinal Bleeding ◽  
Ct Angiography ◽  
Capsule Endoscopy ◽  
Video Capsule Endoscopy ◽  
Gi Bleeding ◽  
Conventional Angiography ◽  
Management Algorithm ◽  
Lower Gi Bleeding ◽  
Diagnostic Modalities

AbstractA variety of diagnostic modalities is available to assist in the evaluation of patients presenting with acute gastrointestinal (GI) bleeding. This article reviews some older technologies like colonoscopy, nuclear scintigraphy, and conventional angiography and will also review the newest additions to the lower GI bleeding diagnostic toolbox, which are video capsule endoscopy and computed tomography (CT) angiography. The management algorithm used at a given institution depends on the available expertise and resources.

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