Gastrointestinal Bleeding

Gastrointestinal bleeding occurs when a pathologic process such as ulceration, inflammation, or neoplasia leads to erosion of a blood vessel. Bleeding can occur in the upper gastrointestinal tract (50%) or the lower gastrointestinal tract (40%) or may be obscure (10%), meaning that no definitive source is identified. Gastrointestinal bleeding is common, with major bleeding leading to 1 million hospitalizations every year in the United States. This review details the pathophysiology of gastrointestinal bleeding and the stabilization and assessment, diagnosis, treatment, and disposition and outcomes of patients with gastrointestinal bleeding. Situations requiring special consideration are also discussed. Figures show how gastrointestinal bleeding occurs when a pathologic process causes erosion of the mucosa and exposes a submucosal blood vessel; an ulcer with a raised, red, variceal spot; a Mallory-Weiss tear; the formation of varices; vascular ectasia; treatment of esophageal varices with balloon tamponade; and a wireless capsule. Tables list the major causes of gastrointestinal bleeding, terms relating to gastrointestinal bleeding and their definitions, Blatchford score, substances that interfere with occult blood testing, clinical factors differentiating gastrointestinal bleeding placed in descending order of likelihood ratio, and a summary of American College of Radiology recommendations for angiography in nonvariceal gastrointestinal bleeding. This review contains 8 figures, 15 tables, and 107 references. Key Words: gastrointestinal bleeding, inflammation, occult blood testing, UGIB, LGIB, Blatchford score, angiography, wireless capsule endoscopy (WCE)

INCIDENCE AND AETIOLOGY OF GASTROINTESTINAL PERFORATION: A HOSPITAL BASED PROSPECTIVE STUDY.

Objectives: This study was to evaluate the incidence and various aetilogical factors in patients of gastrointestinal perforation. Methods: A detail history clinical examinations and relevant investigations were performed to all cases of gastrointestinal perforation. A total of 50 patients of gastrointestinal perforation with age group 0 to 80 years were enrolled. Patients were included on the presenting signs and symptoms like pain, vomiting, distension, alteration of bowel habits, fever, h/o loss of appetite and weight, dyspnoea and duration of illness. Clinical examination was followed by haematological, biochemical and radiological investigations were performed to all cases of gastrointestinal perforation. Results: Data was analysed by using SPSS version 26 software. All data was tabulated and percentages were calculated. One sample t test was applied. Mean and standard deviation were observed. P value was taken less than or equal to 0.05 for significant differences. Conclusions: Gastrointestinal perforation was commonly seen in younger age group. Ileum was the most common site for gastrointestinal perforation. Enteric fever and drugs were the most common aetiological factors of gastrointestinal perforation. Hence, awareness, early recognition of symptoms and referral of patients to hospital is very important for prevention and management of gastrointestinal perforation. Key words: gastrointestinal perforation, aetiological factors, age, sex

Virškinimo trakto stromos navikų chirurginio gydymo principai

Raimundas Lunevičius1, Michitaka Fujiwara2, Juozas Stanaitis11 Vilniaus universiteto Bendrosios ir plastinės chirurgijosortopedijos ir traumatologijos klinika,Šiltnamių g. 29, LT-041302 Nagojos universitetas, 2-asis chirurgijos skyrius, Endoskopinės chirurgijos centras,65 Tsurumai-cho, Showa-ku, Nagoya 466, JaponijaEl. paštas: [email protected] Įvadas / tikslas Chirurginis gydymas yra pagrindinis siekiant išgydyti virškinimo trakto stromos navikais sergančius ligonius. Straipsnio tikslas – apibūdinti šios ligos chirurginio gydymo indikacijas, principus ir vėlyvus rezultatus. Apžvalga Kertiniai klausimai, į kuriuos turi atsakyti klinicistas siekdamas nustatyti GIST chirurginio gydymo indikacijas, yra tokie: (i) ar tai pirminis lokalus chirurgiškai radikaliai pašalinamas GIST; jei taip – tai yra indikacija operuoti visais atvejais; (ii) ar tai yra lokaliai ar atokiai išplitęs GIST (kai naviko radikalaus pašalinimo galimybės yra labai ribotos arba jų nėra); jei taip – tai yra indikacija skirti neoadjuvantinę terapiją imatinibo mezilatu. Tokiu atveju chirurginio gydymo galimybės iš naujo vertinamos praėjus 3, 6, 9 mėn. ir daugiau nuo nepertraukiamo gydymo vaistais pradžios. Tai lemia naviko atsakas į gydymą vaistais. Virškinimo trakto stromos naviko operacijos tikslas – visiškas naviko pašalinimas apimant nepažeistus audinius. Atstumas nuo naviko kraštų turi būti ne mažesnis kaip 1–2 cm. Sisteminė sritinė limfadenektomija nedaroma arba daroma labai retai, tai yra tais atvejais, kai yra metastazių sritiniuose limfmazgiuose. Nustačius recidyvinį ar metastazavusį virškinimo trakto stromos naviką, klinicistui keliami tokie uždaviniai: pirma, išsiaiškinti chirurginės rezekcijos galimybes; antra, pagrįsti imatinibo mezilato skyrimo būtinumą. GIST dvinaris skirstymas į mažo piktybiškumo ir didelio piktybiškumo navikus klinicistui yra priimtinas. Išvada Siekiant pagerinti GIST gydymo rezultatus, būtini tolesni aktyvūs GIST diagnostikos ir gydymo tyrimai. Reikšminiai žodžiai: virškinimo trakto stromos navikai (GIST), chirurginis gydymas, imatinibo mezilatas Principles of surgical treatment of gastrointestinal stromal tumors Raimundas Lunevičius1, Michitaka Fujiwara2, Juozas Stanaitis11 Vilnius University, Clinic of General and Plastic Surgery, Orthopedics and Trauma SurgeryŠiltnamių str. 29 LT-04130 Vilnius, Lithuania2 Nagoya University, 2nd Department of Surgery, Section of Endoscopic Surgery,65 Tsurumai-cho, Showa-ku, Nagoya 466, JapanE-mails: [email protected] Background / objective Surgical resection is the main choice of reliable recovery for GIST patients. The purpose of the article is as follows: to define indications for surgery, the principles of operations due to GIST, and late follow-up results. Review Most important points in defining indications for surgery are the following: (i) is it a primary localized resectable GIST? If yes, it is an absolute indication for surgery; (ii) is it a locally or distantly outspread GIST when the possibilities of surgical resection are very restricted or there are no them; if yes, it is an indication for neoadjuvant imatinib mesylate therapy. There is a need for re-consideration of indications for surgery after 3, 6, 9 and more months after permanent neoadjuvant therapy, depending on response of the tumor to medication. An operation should be aimed to performe complete en block removal of the tumor and the surrounding 1–2 cm length of tissue. A systematic regional lymphadenectomy is not recommended routinely. It is warranted only for evident regional nodal involvement. In case of a recurrent or metastatic disease, there is a necessity to determine the following: first, are threre still any possibilities for surgical resection; second, to motivate the necessity for imatinib mesylate therapy. Binary categorization of GIST into low and high malignant potential tumors is acceptable to clinicians. Conclusion To optimize results of GIST management, a further active research and consensus are needed. Key words: gastrointestinal stromal tumors (GIST), surgery, imatinib mesylate

The complex world of gastrointestinal bacteria

The world of gastrointestinal (GI) bacteria is one of the most complex and intricate of the microbial domain. These bacteria are confronted with a constantly changing (and often hostile) environment, including fluctuations in both physical and chemical conditions. Neighboring microorganisms not only contend for substrate but even launch complex chemical attacks with the apparent purpose of disrupting the activity of their competitors. Yet, some species not only survive, they even flourish, in the GI tract because they possess the ability to adapt to these environmental fluctuations and assaults from other microbes. Such adaptation involves sophisticated programs in the bacterial cell that enable it to monitor its environment and make necessary adjustments of physiological activity and gene expression. Among these adjustments is the ability of cell-to-cell communication, biofilm formation, regulation of cytoplasmic pH, and maintenance of genetic diversity through mutation and horizontal gene transfer. As a consequence, bacteria in the GI tract often manifest very different physiological features than are observed for the same bacteria during routine laboratory cultivation. Key words: Gastrointestinal bacteria, bacteria, gastrointestinal tract, ruminal bacteria, biofilms, quorum-sensing, colonic bacteria

Monoclonal Antibodies for Exercise-Induced Fecal Blood Detection-Comparison With Hemofec

The purpose of this investigation was to determine the incidence of fecal occult blood in marathoners using an immunochemical technique (OC-Hemodia). Five stool specimens (2 pre- and 3 postrace) were collected from 24 male runners (mean age 41.4 ± 9.3 yrs) and analysed for fecal occult blood using the OC-Hemodia test. The results were also compared with a qualitative test (Hemofec) in 12 subjects who were randomly selected from the overall group of 24 runners. With the immunochemical technique, the results evidenced the presence of fecal occult blood in 8 subjects in the first postrace stool specimens. Four of these 8 subjects also tested positive in the second postrace sample, whereas in the third postrace sample only one of them tested positive. With the qualitative test, fecal blood was demonstrated in 10 runners in the first postrace sample. Eight of them tested positive in the second sample, whereas only 5 tested positive in the third sample. The immunochemical technique is recommended for fecal occult blood detection in marathoners. Key words: gastrointestinal bleeding, immunochemical technique, marathon

INTAKE, DIGESTA FILL AND FLOW KINETICS PRE- AND POSTPARTUM

Voluntary intake of pellets increased from 45.99 to 73.15 g/BW0.75, gastrointestinal tract fill increased from 1.63 to 2.73%/BW and mean residence time for liquids was reduced by 3.5 and for particles by 6 h in ewes postpartum compared to prepartum. Key words: Gastrointestinal tract fill, passage rate sheep

DEVELOPMENT OF A TECHNIQUE FOR GASTROINTESTINAL ENDOSCOPY OF DOMESTIC RUMINANTS

A technique of gastrointestinal endoscopy for cattle and sheep is described. To allow passing of an endoscope to specific areas of the gastrointestinal tract, cannulae were placed in the descending duodenum of sheep and the rumen and proximal duodenum of a steer. The endoscopy procedure was performed while the animals were standing, conscious and in a fed state. The endoscope was passed through the cannula and was visually guided to a specific area of the gastrointestinal tract. Endoscopic photographs depicting normal and abnormal morphological features of the reticulo-rumen, omasum and proximal duodenum of sheep and cattle were achieved. Also, a site-specific intestinal epithelium biopsy technique was developed. Key words: Gastrointestinal endoscopy, cannulation, ruminants