Gastrointestinal Bleeding (eBook)

Preface 5
Acknowledgment 6
Contents 7
Contributors 9
Part I Upper GI Bleeding 12
Stabilization of Patients Presenting with Upper GastrointestinalBleeding 13
Introduction 13
Goals of Therapy 16
History 16
Hemodynamic Resuscitation 16
Cessation of Bleeding 17
Endoscopy 17
Esophageal Tamponade 18
Percutaneous 18
Surgery 18
Pharmacological Adjuncts 19
Prevention of Recurrence 19
Conclusions 20
References 20
Urgent Workup for Upper Gastrointestinal Bleeding 23
Introduction 23
Medical Workup 23
Esophagogastroduodenoscopy in Non-variceal Bleeding 25
Endoscopic Findings 26
Arteriography 27
Tagged Red Cell Scan 29
CT Angiography (CTA) 30
Variceal Bleeding 30
Small Bowel Bleeding 31
Summary 31
References 31
Management of Esophageal Variceal Bleeding 33
Introduction 33
Management 34
Prevention of Initial Bleed 34
Management of Acute Bleeding 35
Conclusion 39
References 39
Management of Dieulafoys Lesions 41
Introduction 41
Pathophysiology 41
Risk Factors 42
Clinical Presentation 42
Clinical Management 43
Summary 45
References 46
Management of Bleeding Peptic Ulcer Disease 48
Epidemiology 48
Presentation 51
Initial Management 51
Risk Stratification 52
Endoscopic Therapy 56
Medical Therapy 59
Interventional Therapy 61
Surgical Therapy 65
References 67
Management of Unusual Sources of Upper GI Bleeding 74
GAVE: Gastric Antral Vascular Ectasia 74
Aortoenteric Fistula 76
Arteriovenous Malformation 81
Hemorrhagic Gastritis 83
Summary 85
References 85
MalloryWeiss Syndrome 87
Introduction 87
Etiology and Pathogenesis 87
Presentation 88
Diagnosis 88
Treatment 88
Conclusion 91
References 92
Management of Bleeding Small Bowel Tumors 93
Introduction 93
Epidemiology of Bleeding Small Bowel Tumors 94
Approach to Patients with Bleeding Small Bowel Neoplasms 95
Low-Yield Tools 96
Higher Yield Tools 99
Management of Bleeding Small Bowel Neoplasms 100
Bleeding Small Bowel Neoplasms 101
Benign Small Bowel Tumors 101
Malignant Small Bowel Tumors 104
Summary 107
References 107
Management of Bleeding from the Bile Duct 111
Presentation and Differential Diagnosis 111
Pathophysiology and Etiology 112
Diagnostic Work-Up 114
Therapy 115
References 117
Management of Bleeding from the Pancreas 119
Introduction 119
Surgical Anatomy 119
Clinical Presentation 120
Diagnostic Studies 121
Pathophysiology 122
Management 122
Conclusion 123
References 123
Part II Lower GI Bleeding 126
Urgent Workup of Lower GI Bleeding 127
Introduction 127
Resuscitation and Stabilization for Massive LGIB 130
Urgent Colonoscopy 131
Urgent Arteriography 133
Urgent Tagged Red Blood Cell Scan 134
References 137
Bleeding Hemorrhoids 139
Introduction 139
Diagnosis 139
Treatment 142
References 148
Management of Bleeding Colitis and Colonic Diverticular Disease 151
Bleeding Colitis 151
Infectious and Antibiotic-Associated Colitis 151
Ulcerative Colitis 152
Ischemic Colitis 154
Necrotizing Enterocolitis (NEC) 154
Diverticular Disease 155
Diagnosis and Therapeutic Options 155
Colonoscopy 156
Angiography 158
Other Tests 158
Surgical Approach 159
References 159
Colonic Arteriovenous Malformations 161
Introduction 161
Initial Work-Up and Diagnosis 162
Imaging Studies 162
Colonoscopy 163
Angiography 164
Other Tests 164
Treatment 164
Non-surgical Approach 164
Surgical Treatment 165
References 166
Bleeding Colonic Tumors 168
Introduction 168
Overview 168
Etiology 169
Evaluation 169
Treatment 170
Summary of Management: Key Points 173
References 174
Part III GI Bleeding from an Unknown Source 177
Evaluation of the Guaiac Positive Patient 178
Introduction 178
Fecal Occult Blood 178
Commercially Available Fecal Occult Blood Tests 179
Guaiac-Based Tests 179
Heme--Porphyrin-Based Tests 180
Immunochemical-Based Tests 180
Differential Diagnosis 181
Iron-Deficiency Anemia 181
Differential Diagnosis 181
Approach to Evaluation of Occult Gastrointestinal Blood Loss 182
References 183
Obscure GI Bleeding: Capsule and Double-Balloon Techniques 185
Introduction 185
Wireless Capsule Endoscopy 185
Indications, Contraindications, and Complications 186
Efficacy 188
Double-Balloon Enteroscopy 189
Technique 189
Indications, Contraindications, and Complications 191
Efficacy 192
Summary 193
References 194
Provocative Angiography 197
Introduction 197
Review 198
Complications and Risk Assessment 199
Methods 200
Conclusions 200
References 204
The Unstable Patient with Obscure Gastrointestinal Bleeding: Surgical and Non-surgical Management 205
Obscure Gastrointestinal Bleeding Definitions, Causes, and Epidemiology 205
Initial Management and Approach to the Unstable OGIB Patient 206
Laparoscopic Approach to Diagnosis and Management of OGIB 208
Summary 210
References 211
Subject Index 213