Causes of Melena and Effective Examination Strategies in Children

Background and Aim: Melena, or tarry black stool, is not a rare symptom encountered in pediatric clinical practice, and the bleeding source varies from the upper gastrointestinal tract to the small intestine. Endoscopy is effective in identifying bleeding, but it does not always identify the source of bleeding. Endoscopic examination in children is commonly challenging, and there are no detailed reports about the causes of melena in children. This observational study aimed to validate the cause of melena in children and to investigate more effective and less burdensome examination methods.Methods: We retrospectively reviewed the clinical records of 55 patients who underwent examination for melena.Results: In this research, 38 patients had underlying diseases such as malignancy and severe mental and physical disorders. The bleeding source was identified in 39 patients. The most common final diagnosis was duodenal ulcer (n = 22), and the other diagnoses were gastric ulcer, esophagitis, and esophageal varices. The upper gastrointestinal tract was the most common source of bleeding (n = 34). In five patients, the bleeding source was the small intestine. Vomiting, abnormal abdominal ultrasonography findings, and a hemoglobin level of ≤ 3 g/dL than the lower normal limit were significant factors indicating that the bleeding source can be found on esophagogastroduodenoscopy.Conclusions: The upper gastrointestinal tract was the most common bleeding source of melena in children. As in adults, esophagogastroduodenoscopy is the primary endoscopic method of choice. Furthermore, small bowel capsule endoscopy may be useful in identifying the bleeding source in children without upper gastrointestinal lesions.

Download Full-text

Epithelial surfaces of the upper gastrointestinal tract of the blue-tongues lizard, Tiliqua scincoides: a scanning electron microscope study

Australian Journal of Zoology ◽

10.1071/zo9780241 ◽

1978 ◽

Vol 26 (2) ◽

pp. 241 ◽

Cited By ~ 5

Author(s):

AS Giraud ◽

CR Hunter ◽

John DJB St

Keyword(s):

Small Intestine ◽

Gastrointestinal Tract ◽

Epithelial Cells ◽

Gastric Epithelium ◽

Upper Gastrointestinal Tract ◽

Surface Epithelium ◽

Transmission Microscopy ◽

Scanning Electron Microscope Study ◽

Upper Gastrointestinal ◽

Scanning Electron

The surface epithelium of the oesophagus, stomach and small intestine of healty T. scincoides was examined by scanning electron microscopy and the findings confirmed by both light and transmission microscopy. The oesophagus was lined by ciliated, goblet and microvillous cells. Its topography appeared similar to the trachea and major bronchi of a number of mammals and birds. Throughout the length of the stomach microvillous cells were uniformly arranged on the gastric rugae. The cells were slightly convex and sparsely populated by microvilli, which appeared more numerous at intercellular margins. Swollen epithelial cells, approximately twice the size of the adjacent cells, were scattered throughout the gastric epithelium. Cells with focal apical erosions were found in isolated regions, being relatively more numerous in the distal stomach. The openings of the gastric glands were observed as invaginations of the epithelial surface and were most prominent near the tops of the gastric rugae. The small intestine was lined by epithelial cells covered by long, densely packed microvilli. Goblet cells were interspersed along the surface of the intestinal villi. Except for the oesophagus, the topography of the upper gastrointestinal tract of T. scincoides closely resembles that of homologous regions of the mammalian gut.

Download Full-text

Distribution of heat shock protein 70 expression in human upper gastrointestinal tract and small intestine

Gastroenterology ◽

10.1016/s0016-5085(98)84742-2 ◽

1998 ◽

Vol 114 ◽

pp. A1166

Author(s):

T. Mullick ◽

M. Motevalli ◽

S. Vinayek ◽

UK. Tantry ◽

PP. Nair ◽

...

Keyword(s):

Small Intestine ◽

Gastrointestinal Tract ◽

Heat Shock ◽

Heat Shock Protein ◽

Heat Shock Protein 70 ◽

Upper Gastrointestinal Tract ◽

Upper Gastrointestinal

Download Full-text

High Incidence of Upper Gastrointestinal Tract Involvement in Children With Crohn Disease

PEDIATRICS ◽

10.1542/peds.83.5.777 ◽

1989 ◽

Vol 83 (5) ◽

pp. 777-781

Author(s):

C. Lenaerts ◽

C. C. Roy ◽

M. Vaillancourt ◽

A. M. Weber ◽

C. L. Morin ◽

...

Keyword(s):

Ulcerative Colitis ◽

Gastrointestinal Tract ◽

Children And Adolescents ◽

Chronic Ulcerative Colitis ◽

Crohn Disease ◽

Bowel Disease ◽

Upper Gastrointestinal Tract ◽

Indeterminate Colitis ◽

Gastrointestinal Lesions ◽

Upper Gastrointestinal

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P < .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/ or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.

Download Full-text

Gastritis: A Common Source of Acute Bleeding in the Upper Gastrointestinal Tract?

Southern Medical Journal ◽

10.1097/00007611-199007000-00012 ◽

1990 ◽

Vol 83 (7) ◽

pp. 769-770 ◽

Cited By ~ 2

Author(s):

NESHAN TABIBIAN ◽

FRED M. SUTTON

Keyword(s):

Gastrointestinal Tract ◽

Upper Gastrointestinal Tract ◽

Common Source ◽

Acute Bleeding ◽

Upper Gastrointestinal

Download Full-text

CORRELATIVE STUDY OF HISTOPATHOLOGICAL DIAGNOSIS WITH CLINICAL & ENDOSCOPIC DIAGNOSIS IN UPPER GASTROINTESTINAL ENDOSCOPIC BIOPSY AT TERTIARY CARE CENTER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i2.1737 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Shana Nikhat Khan ◽

Sanjeev Narang

Keyword(s):

Gastrointestinal Tract ◽

Clinical Diagnosis ◽

Histopathological Examination ◽

Care Center ◽

Tertiary Care ◽

Upper Gastrointestinal Tract ◽

Histopathological Diagnosis ◽

Surgical Department ◽

Gastrointestinal Lesions ◽

Upper Gastrointestinal

Lesions of Upper gastrointestinal tract (GIT) is commonly seen in surgical department patients. These patients are subjected to endoscopic examination and biopsy is taken for further histopathological diagnosis. A clinical, endoscopic and histopathological diagnosis is made. This study was done to compare and correlate the results of histopathological diagnosis with endoscopic and clinical findings. Study Designed: A total 50 Upper Gastrointestinal tract biopsy cases received in histopathology lab were analyzed. Material and Method: All endoscopic biopsies from upper GIT were received and processed. Paraffin blocks were made and sections were cut at 4 microns thickness and stained with routine hematoxylin and eosin stain. Their clinical and endoscopic reports were collected and compared with histopathological diagnosis. Result: After analyzing statistically the data, we found that endoscopy results were better than clinical diagnosis and more closer to histopathological diagnosis. Conclusion: Relation of histopathological diagnosis with endoscopic findings & clinical diagnosis was done in our study. We conclude that endoscopy is incomplete without histopathological examination of biopsy & so, the combinations of both plays an important role in diagnosis & management of upper gastrointestinal tract disorders. Histopathological examination remains the gold standard. Keywords: Histopathology, endoscopy, gastrointestinal lesions.

Download Full-text

Microbial Contamination of the Gut; another Feature of Malnutrition

Paediatrica Indonesiana ◽

10.14238/pi15.7-8.1975.181-90 ◽

2017 ◽

Vol 15 (7-8) ◽

pp. 181 ◽

Cited By ~ 1

Author(s):

Michael Gracey ◽

Suharjono Suharjono ◽

Sunoto Sunoto ◽

Delys E. Stone

Keyword(s):

Small Intestine ◽

Gastrointestinal Tract ◽

Microbial Contamination ◽

Anaerobic Bacteria ◽

Microbial Flora ◽

Upper Gastrointestinal Tract ◽

Candida Sp ◽

Large Numbers ◽

Upper Gastrointestinal

The microbial flora of the stomach and upper small intestine was studied in 21 malnourished Indonesian children with diarrhoea and compared with that found in 21 Australian children of Caucasian extraction with a variety of alimentary disorders. In the Indonesian children there was marked microbial contamination of the upper gastrointestinal tract with a wide variety of microorganisms. In several patients there was significant overgrowth by Candida sp. and in several others large numbers of anaerobic bacteria were isolated. It is suggested that these microbiological abnormalities are related to the pathogenesis of diarrhoea in children with malnutrition.

Download Full-text

DIAGNOSTIC IMAGING AND ENDOSCOPY OF THE SCHNAUZER DOG WITH UPPER GASTROINTESTINAL TRACT DISORDERS

Jurnal Kedokteran Hewan - Indonesian Journal of Veterinary Sciences ◽

10.21157/j.ked.hewan.v11i1.5446 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1-5

Author(s):

Deni Noviana ◽

Kholis Afidatunnisa ◽

Annisa Rofiqoh Syafikriatillah ◽

M. Fakhrul Ulum ◽

Gunanti Gunanti ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Chemical Analysis ◽

Diagnostic Imaging ◽

Physical Examination ◽

Mucosal Surface ◽

Upper Gastrointestinal Tract ◽

Abdominal Radiograph ◽

Abdominal Ultrasonography ◽

Abdominal Organs ◽

Upper Gastrointestinal

The aim of this study was to describe the role of diagnostic imaging and endoscopy to define the diagnose of the upper gastrointestinal tract disorder of the Schnauzer. The information from the owner stated that the dog has been vomiting for a year, sometimes containing blood. There might also be a possibility that it had eaten a corpus alienum. This case study covered physical examination, hematology and blood chemical analysis, diagnostic imaging radiography and ultrasonography as well as endoscopy performed. Physical examination showed weight loss and anorexia. Hematology and blood chemical analysis showed an increase in hemoglobin, hematocrit, lymphocyte, ureum, creatinine, alanine aminotransferase (ALT), and alkaline phosphatase (ALP) values. Abdominal radiograph showed no abnormality in the abdominal organs. Abdominal ultrasonography showed a hiperechoic elongated mass attached on the stomach mucosal surface which forms an acoustic shadowing at the ventral. Endoscopy showed pathological lesions that is inconsistency of stomach mucosa surface, foamy fluid in the stomach, ulcers and erosion of the stomach mucosal surface. Based on the diagnostic imaging and endoscopy performed, the animal was clearly diagnosed with chronic gastritis accompanied by stomach ulcer and erosion.

Download Full-text