GASTROINTESTINAL BLEEDING: SYMPTOMS, TREATMENT AND PROGNOSIS

GASTROINTESTINAL BLEEDING: SYMPTOMS, TREATMENT AND PROGNOSIS

Library of Congress Cataloging-in-Publication Data

Contents

Preface

Acknowledgment

Chapter 1: Gastrointestinal Bleeding: Diagnosis and Outcomes

Abstract

Upper GI Bleeding

Introduction

Symptoms, Signs and Etiology of Upper GI Bleeding

1. Variceal Bleeding

2. Non Variceal Bleeding

A- Peptic Ulcer Disease

B- Erosive Mucosal Diseases

C- Gastric Tumors

3. Upper GI Bleeding In HIV Infected Patients

Symptoms and Signs of Hemodynamic Stability

Diagnosis of Upper GI Bleeding

1. Acute GI Bleeding

A- Laboratory Investigations

B- Diagnostic Studies

2. Chronic GI Bleeding (Obscure and Occult Bleeding)

A- Testing for Occult Blood

B- Endoscopy

Outcome of Upper GI Bleeding

1. Risk Stratification

2. Scoring System in Upper GI Bleeding

Lower GI Bleeding

Introduction

Symptoms, Signs and Etiology of Lower GI Bleeding

1. Colonic Causes

Infective Colitis:

2. Anorectal Diseases

3. Small Bowel Diseases

4. Post Polypectomy

Diagnosis of Lower GI Bleeding

1. Laboratory Investigations

2. Diagnostic Procedures

E- Enteroscopy: Push enteroscopy has both diagnostic and therapeutic capabilities, but typically only examines that part of the small bowel that is 50 to 150 cm distal to the ligament of Treitz.

Outcome of Lower GI Bleeding

References

Chapter 2: Dieulafoy Lesions As a Cause of Gastrointestinal Bleeding

Abstract

Introduction

Epidemiology

Pathogenesis

Definitions

Clinical Presentations

Gastric DLs

Intestinal DLs

Differential Diagnosis of Upper GI Bleeding

Investigations

Intestinal

Pathologic Features

Treatment

Prognosis

Conclusion

References

Chapter 3: Early Risk Assessment of Patients Presented with Upper Gastrointestinal Bleeding

Abstract

Introduction

Existing Risk Scores and Comparative Studies

Endoscopy-Based Scores

Pre-Endoscopy Scores

Clinical Use of Scoring Systems

Conclusion

References

Chapter 4: Diagnostic Imaging of Gastrointestinal Bleeding

Abstract

Introduction

Acute Gastrointestinal Bleeding

Obscure Gastrointestinal Bleeding

Diagnostic Imaging for GI Bleeding

Radionuclide Imaging

Multidetector CT Angiography

CT Enterography

Catheter-Directed Mesenteric Angiography

Conclusion

References

Biographical Sketch

Chapter 5: Management of Patients with Acute GI Bleeding: Advances in Endoscopic Therapy

Abstract

Introduction

Initial Management of Acute Gastrointestinal Bleeding

Hemodynamic Resuscitation

Nasogastric Lavage

Blood Products

Correction of Coagulopathy

Risk Assessment

Pre-Endoscopic Pharmacologic Therapy

Proton-pump Inhibitors

Prokinetic Therapy

Vasoconstrictors

Antibiotics

Endoscopic Management

Timing of Endoscopy

Endoscopic Risk Assessment

Endoscopic Therapy for Non-Variceal Upper GI Bleeding

Endoscopic Therapy for Variceal Upper GI Bleeding

Endoscopic Therapy for Lower GI Bleeding

Endoscopic Therapy for Middle GI Bleeding

Emerging Endoscopic Therapies

Treatment after Failed Endoscopy

Medical Therapy after Endoscopy

Prevention of Recurrent Non-Variceal Hemorrhage

Prevention of Rebleeding from Esophageal Varices

Anticoagulation

Conclusion

References

Biographical Sketches

Biographical Sketch

Chapter 6: Endovascular Management of Nonvariceal Upper Gastrointestinal Bleeding

Abstract

Introduction

Clinical Presentation

Management of Non-Variceal Upper Gastrointestinal Bleeding

Imaging Studies

Arterial Anatomy of the Upper GI Tract

Angiographic Techniques

Embolotherapy

Coils

Particulate Agents

1. Gelatin Sponge

2. Polyvinyl Alcohol

3. Trisacryl Gelatin Microspheres

Amplatzer Vascular Plugs

Liquid Embolic Agents

Intra-Arterial Vasopressin Therapy

Conclusion

References

Chapter 7: Endovascular Management of Nonvariceal Lower Gastrointestinal Bleeding

Abstract

Introduction

Epidemiology and Causes

Diagnosis, Evaluation and Management

1. Colonoscopy

2. Radionuclide Imaging

3. Multi-Detector Computed Tomography and Computed Tomography Angiography

4. Wireless Capsule Endoscopy

5. Angiography

A. Anatomic Considerations

B. Angiographic Technique

Transcatheter Intervention

1. Intra-Arterial Vasopressin Infusion

2. Transcatheter Embolotherapy

Conclusion

References

Chapter 8: Variceal Hemorrhage

Abstract

Introduction

Pathophysiology of Varices Formation and Variceal Hemorrhage

Management of Variceal Hemorrhage

Prevention of Variceal Hemorrhage

Patients with Cirrhosis and No Varices

Patients with Cirrhosis and Small Varices

Patients with Cirrhosis and Large Varices

Management of Acute Variceal Hemorrhage

Volume Resuscitation

Antibiotic Prophylaxis

Pharmacologic Therapy

Endoscopic Therapy

Combination of Pharmacologic Therapy and EVL

Rescue Therapies

Management of Gastric Varices

Secondary Prevention of Variceal Hemorrhage

Conclusion

References

Chapter 9: Transjugular Intrahepatic Portosystemic Shunt

Abstract

Introduction

The Role of Tips in Portal Hypertension

and Variceal Bleeding

Portal Pressure Gradient and Variceal Bleeding

Tips for Secondary Prophylaxis

Contraindications to Tips Placement

Technical Considerations

Hepatic and Portal Vein Anatomy

1. Hepatic Vein Anatomy

2. Portal Vein Anatomy

TIPS Technique

Pre-Procedure Requisites

The Procedure

Endograft Positioning and Delivery

Direct Intrahepatic Portocaval Shunt

Tips Complications

Endograft Shunt Dysfunction

Other Complications

Conclusion

References

Biographical Sketch

Chapter 10: Surgical Management of Gastroesophageal Varices

Abstract

Introduction

Variceal Bleeding

Normal Portal Venous Anatomy and Physiology

Portal Hypertension Pathophysiology

Portal Pressure Measurements

Natural History of Varices

Pharmacologic Treatment of Variceal Bleeding

Endoscopic Treatment of Esophageal Varices

Surgical Management of Variceal Bleeding

Non-Selective Shunts

Transjugular Intrahepatic Portosystemic Shunt

Non-Selective Surgical Shunt

Selective Shunts

Non-Shunt Surgical Therapy

References

Index