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Acute Gastrointestinal Bleeding: Diagnosis and Treatment by Karen E. Kim

By Karen E. Kim

Major specialists within the fields of gastroenterology, surgical procedure, and radiology comprehensively evaluation the pathophysiology, analysis, administration, and remedy of acute bleeding problems of the GI tract. The authors holiday down acute bleeding into higher and decrease GI tract assets and supply a differential prognosis for every illness, evidence-based algorithms for scientific perform, therapy modalities for its administration, and criteria of care. The authors define the numerous dilemmas confronted by way of physicians of their method of their sufferers, similar to localization of the bleeding resource (upper vs lower), the necessity and timing for emergency endoscopy, and the timing for radiologic intervention and/or surgical procedure.

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Extra resources for Acute Gastrointestinal Bleeding: Diagnosis and Treatment (Clinical Gastroenterology)

Example text

There is also a report of recurrent 28 Stevoff and Hirano massive acute upper GI bleeding attributed to a vagal neurilemoma diagnosed at thoracotomy (116). When possible, endoscopic therapy should be attempted. If bleeding persists, surgical intervention may be necessary. Esophagoarterial Fistula Esophagoaortic fistulae formations in the setting of esophageal carcinoma or nasogastric intubation have already been discussed. There has been a single report of esophagoaortic fistula presenting with massive bleeding attributed to reflux esophagitis (117).

Care should be taken to evaluate for signs of perforation by monitoring vital signs, examination for crepitus in the chest and neck, and chest radiograph if doubt persists. Patients should be encouraged to sit upright and take an adequate amount of fluid with pills to minimize the risk of this condition. Topical agents such as sucralfate or lidocaine are sometimes used for symptomatic relief, although there are no data on their efficacy. Endoscopic evaluation is recommended when the diagnosis of pill esophagitis is uncertain or in cases of significant hemorrhage.

J Infect Dis 1993; 167: 547–552. 56. Rabeneck L, Popovic M, Gartner S, et al. Acute HIV infection presenting with painful swallowing and esophageal ulcers. JAMA 1990; 263: 2318–2322. 57. Gill MJ, Sutherland LR, Church DL. Gastrointestinal tissue cultures for HIV in HIV-infected/AIDS patients. The University of Calgary Gastrointestinal/HIV Study Group. Aids 1992; 6: 553–556. 58. Kodsi BE, Wickremesinghe C, Kozinn PJ, Iswara K, Goldberg PK. Candida esophagitis: a prospective study of 27 cases. Gastroenterology 1976; 71: 715–719.

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