2011 Lower GI Bleeding ADALQU
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Plus de Adolfo Aliaga Quezada
2011 Lower GI Bleeding ADALQU
- 1. Hemorragia Digestiva Baja (HDB) Radiología Intervencional Centro Imagenología Hospital Clínico Universidad de Chile Departamento de Radiología Facultad de Medicina Universidad de Chile Dr. Adolfo Aliaga Quezada Residente de Radiología
- 5. Etiología Radiographics . 2007; 27:1055–1070
- 6. Hemorroides prolapsados sangrantes F i sura anal Sabiston Textbook of Surgery, 18th ed.
- 7. Proctitis actínica Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed. Úlcera rectal solitaria
- 8. Etiología Gastroenterol Clin North Am. 2005; 34: 643-664 95% 5%
- 9. Etiología Gastroenterol Clin North Am. 2005; 34: 643-664
- 14. Mucosal and submucosal venous drainage is intermittently obstructed by muscular contraction or increased intraluminal pressure (panels A, B, and C). After many years of intermittent obstruction, submucosal veins may become dilated and tortuous (panel D) and involve additional veins and venules draining into the system. Eventually, the capillary ring dilates and the precapillary sphincter becomes incompetent resulting in a small arteriovenous communication lesion. Boley, SJ, Sammartano, R, Adams, R, et al. On the nature and etiology of vascular ectasias of the colon: Degenerative lesions of aging. Gastroenterology 1977; 72:650-660.
- 15. K. Elsayes. Radiographics . 2010; 30: 1955-1970
- 17. Manejo ayúdeme HTA DM ERC SETTING ASA 4 anemia shock 70 años
- 19. Eisen GM, Dominitz JA, Faigel DO, et al; American Society for Gastrointestinal Endoscopy, Standards of Practice Committee. An annotated algorithmic approach to acute lower gastrointestinal bleeding. Gastrointest Endosc 2001;53:859-863.)
- 22. Extravasación intraluminal en ileon
- 33. Conclusiones
- 34. J Gastrointest Surg. 2008; 12: 2212–2220
Notes de l'éditeur
- Decrease of more than 5% hematocrit points in <12 h; (d) transfusion of >3 units of packed red blood cells; (e) hemodynamic instability in previous 6 h defined by: angina, syncope, presyncope, orthostatic vital signs, mean arterial blood pressure <80 mmHg, or resting pulse >110.
- In radiation proctitis, vascular telangiectasia and nonhealing mucosal ulceration, perhaps caused by an underlying obliterative arteritis, may lead to severe recurrent haemorrhage. The nonendoscopic management of bleeding secondary to radiation proctitis includes the use of sucralphate or formalin enemas. Sucralphate is a highly sulphated polyanionic dissacharide. In this setting, its postulated mechanisms of action include stimulation of epithelial healing and formation of a protective barrier.
- MDCT scan obtained in 71-year-old woman with hematochezia from bleeding sigmoid diverticulum shows extravasated contrast material (arrow) flowing into lumen.
- Angiodysplasia. Axial (a) and coronal reformatted (b) CT enterographic sections demonstrate a tuftlike area of enhancement in the medial cecal wall (arrow), a finding suggestive of angiodysplasia
- A normal healthy patient. A patient with mild systemic disease. A patient with severe systemic disease. A patient with severe systemic disease that is a constant threat to life. A moribund patient who is not expected to survive without the operation. A declared brain-dead patient whose organs are being removed for donor purposes.
- Algorithm for the management of acute lower gastrointestinal bleeding (part 2). AVM, Arteriovenous malformation; UPRBC, units of packed red blood cells; TRBC, tagged (radiolabeled) red blood cell.
- In patients with active bleeding, 1 or 2 mL aliquots of epinephrine (dilution, 1:10,000) was injected into each of four quadrants around the lesion to control bleeding. A sulphate or polyethylene glycol (PEG)-based purge (e.g. GoLytely; Braintree Laboratories, Braintree, MA, USA) is administered orally. [For patients who are not able to drink a litre of purge solution every 30-45 min until the effluent clears (usually 5-8 L total), administration via an NG tube is recommended.] Approximately 30 min before the purge is started, 10 mg metoclopramide can be administered intravenously for its prokinetic and antiemetic properties. The dose can be repeated every 4-6 h if nausea results or if further purge is necessary. Occasionally, patients with chronic kidney disease may require dialysis after purging, and those with severe congestive heart failure may require diuresis.
- 83-year-old woman who presented with hematochezia. Contrast-enhanced arterial phase axial MDCT scan shows intraluminal contrast material extravasation (arrow) in ileum. Normal mucosal enhancement (arrowheads) is also shown.
- The relative disadvantage of using [99Tcm] pertechnetate-labelled red blood cells is the persistence of background activity in blood vessels and the blood pool throughout the study, thereby theoretically increasing the threshold for the amount of bleeding needed for detection. In contrast, technetium sulphur colloid, which completely clears the blood pool by 10-15 min after injection, is easier to detect because background activity is absent.
- A longeracting synthetic vasopressin analogue (terlipressin) has been used successfully as a single bolus intra-arterial injection to stop lower gastrointestinal bleeding.
- A longeracting synthetic vasopressin analogue (terlipressin) has been used successfully as a single bolus intra-arterial injection to stop lower gastrointestinal bleeding.
- Technical success was defined by immediate cessation of extravasation on repeat angiography at the end of the embolization procedure. Clinical success was defined as the absence of recurrent bleed or hemodynamic instability within 30 days after embolization, as shown by close patient follow-up: patients were monitored immediately after the embolization procedure for symptoms and signs of intestinal ischemia or infarction (abdominal pain/tenderness, fever, nausea, peritoneal signs). Clinical success was subdivided into total success (i.e., resolution of signs or symptoms that prompted the embolization procedure), partial success (i.e., significant improvement of signs or symptoms after the embolization procedure and positive impact on the clinical course of the patient and/or the subsequent need for reintervention), or failure . Any lower GI rebleeding occurring later than 30 days after embolization was defined as delayed .