1/56. Duodenal ulceration into the cystic artery with massive hemorrhage.This is a case presentation of a unique cause of intestinal bleeding. A duodenal ulcer eroded into the superficial branch of the cystic artery, causing massive intestinal hemorrhage. The patient, a 76-year-old woman, presented with left upper abdominal and left back pain secondary to cystic lesions in the pancreas body and tail. Stress after operation and complication of leakage of pancreatic juice after distal pancreatectomy with splenectomy and diclofenac sodium administration may have caused a deep peptic ulcer to erode the cystic artery. We performed a transfixing ligation of the bleeding vessel, serosal suture of ulcer of the gallbladder, and simple closure of the duodenal ulcer with covering greater omentum. There were no serious complications after the operation, and the patient made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = back pain, upper, back, pain (Clic here for more details about this article) |
2/56. Acute upper gastrointestinal bleed: a case study.Upper gastrointestinal (UGI) bleeding on a presenting symptom is of major significance for nurse practitioners in any clinical setting. Bleeding in the upper gastric tract is a symptom of a disease process rather than a disease in itself. UGI bleeding accounts for 300,000 hospitalizations annually. An astute knowledge of the pathophysiology and clinical presentations of UGI bleeding enables swift intervention and a reduction in morbidity and mortality rates. This article presents a case report of a white male in his fifties diagnosed with metastatic colon cancer and acute UGI bleeding and emphasizes the need for early screening and detection, disease education, and prompt interventions to minimize associated complications.- - - - - - - - - - ranking = 0.73023206215106keywords = upper (Clic here for more details about this article) |
3/56. Postbulbar duodenal ulcer.Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.- - - - - - - - - - ranking = 0.026478810800539keywords = pain (Clic here for more details about this article) |
4/56. Use of the intra-aortic balloon pump to stop gastrointestinal bleeding.Temporary aortic occlusion can be lifesaving in selected conditions. We describe the unorthodox use of an intra-aortic balloon pump without counterpulsation to achieve temporary vascular control in a patient with shock caused by rapid upper gastrointestinal bleeding. The technique of aortic balloon occlusion has been reported in several clinical circumstances, primarily trauma. However, its use to increase blood pressure and gain time for resuscitation before laparotomy for catastrophic gastrointestinal bleeding has not previously been described.- - - - - - - - - - ranking = 0.14604641243021keywords = upper (Clic here for more details about this article) |
5/56. Recurrent giant longitudinal duodenal ulcer with massive hemorrhage in a helicobacter pylori-negative patient.A 67-year-old man, in whom a linear ulcer running from the duodenal bulb to the descending part had been noted 3 years previously, was admitted to our hospital because of abdominal pain and melena. duodenoscopy revealed a bleeding giant longitudinal ulcer, which was more extensive than before. Tests for Helicobacter pylori (Hp) were negative. The ulcer was cured by endoscopic hemostasis and repeated blood transfusions. attention must be paid to Hp-negative post-bulbar duodenal ulcers because of the frequent complications including hemorrhage.- - - - - - - - - - ranking = 0.095020119031189keywords = abdominal pain, pain (Clic here for more details about this article) |
6/56. Management of massive upper gastrointestinal haemorrhage from multiple sites of peptic ulceration with somatostatin and octreotide--a report of five cases.Surgical management of massive upper gastrointestinal bleeding after failed medical treatment may be hazardous because of diffuse bleeding from several sites, further complicated in some patients by intercurrent disease, age, or previous surgery. Experience with combined somatostatin and octreotide therapy in five such patients is described. All were treated initially with either intravenous somatostatin (250 micrograms/hour) or octreotide (Sandostatin) (50 micrograms/hour) for periods ranging from three to five days, after which they were given subcutaneous octreotide (50 or 100 micrograms three times daily). Bleeding was controlled by this regimen in all cases. The patients were all discharged from hospital on either ranitidine (n = 4) or omeprazole (n = 1). Repeat endoscopy at the end of the treatment period with somatostatin and octreotide (n = 1) or four weeks after discharge (n = 3) showed complete healing of the bleeding sites. somatostatin and octreotide may be of value in controlling severe upper gastrointestinal bleeding in patients in whom surgery is hazardous because of bleeding from several peptic lesions further complicated in some by intercurrent disease or age.- - - - - - - - - - ranking = 0.87627847458127keywords = upper (Clic here for more details about this article) |
7/56. Islet cell tumor arising from a heterotopic pancreas in the duodenal wall with ulceration.A rare case of symptomatic islet cell tumor arising from heterotopic pancreas in the duodenum with ulceration is described. Gastrointestinal bleeding was the only sign observed in this patient. Tagged red blood cell scan, upper endoscopy, and computed tomography scan showed active bleeding ulcer from a periampullary mass. Removal of the submucosal tumor was done to prevent future re-bleeding. Histologic and immunohistochemical characterization of the tumor showed an endocrine tumor that expressed a variety of endocrine peptides.- - - - - - - - - - ranking = 0.14604641243021keywords = upper (Clic here for more details about this article) |
8/56. octreotide in the management of postoperative enterocutaneous fistulas and stress ulcer bleeding.We report two clinical experiences in the treatment of postoperative enterocutaneous fistula and stress ulcer bleeding with octreotide acetate (Sandostatin). In both patients, upper gastrointestinal bleeding occurred 7 days after operation, and the bleeding proved to be stress ulceration, by panendoscopic examination. Enterocutaneous fistulas also were found in both patients. One was high output (750 ml/day), and the other was low output (50 ml/day). octreotide 50-100 micrograms was given subcutaneously every 8 h. After three doses of octreotide, a significant reduction in fistula output and control of the stress ulcer bleeding were noted. The fistulas closed promptly after nine doses of octreotide, but the first patient's fistula recurred 2 days later, with fluid losses of about 100-200 ml/day. This fistula closed spontaneously 1 month after discharge. octreotide appears to be useful as an adjunct to the conventional treatment of enterocutaneous fistulas, especially those complicated by stress ulcer bleeding.- - - - - - - - - - ranking = 0.14604641243021keywords = upper (Clic here for more details about this article) |
9/56. Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers.Primary gastric lymphoma is a rare tumour. It is thought that low grade gastric mucosa associated lymphoid tissue lymphoma has not been previously reported to occur in a patient with gastrojejunostomy. This report describes such a case. The patient presented with bleeding from non-healing stomal ulcers. The ulcers healed and there was regression of the tumour after eradication of helicobacter pylori.- - - - - - - - - - ranking = 0.58418564972085keywords = upper (Clic here for more details about this article) |
10/56. Use of acid-suppression therapy for treatment of non-variceal upper gastrointestinal bleeding.PURPOSE: Prognostic factors in patients with peptic ulcer bleeding and therapeutic strategies for preventing the recurrence of bleeding are described. SUMMARY: The risk of complications and death in a patient with acute upper gastrointestinal bleeding can be predicted based on certain clinical factors, the most important being the endoscopic findings. proton pump inhibitors (PPIs) are the drugs of choice for patients with peptic ulcer bleeding because the drugs are more effective than histamine H2-receptor antagonists for maintaining the target intragastric pH (6 or higher) and preventing the recurrence of peptic ulcer bleeding, although an impact on mortality has not been demonstrated. High-dose intravenous PPI therapy should be used for patients at high risk of rebleeding (based on endoscopic findings). Oral PPI therapy may be used for low-risk patients. Underlying causes of ulcers should also be addressed and treated as necessary. CONCLUSION: Acid-suppression therapy using PPIs is effective for reducing the risk for recurrence of peptic ulcer bleeding.- - - - - - - - - - ranking = 0.73023206215106keywords = upper (Clic here for more details about this article) |
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