1/20. 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 = 1keywords = tract (Clic here for more details about this article) |
2/20. Ulcer perforation in gastric urinary conduit: never use a gastric segment in the urinary tract if there are other options available.A male patient, who had had a conservatively treated hemorrhagic peptic ulcer 12 years earlier, underwent gastrocystoplasty after radical cystoprostatectomy for carcinoma of the urinary bladder. After operation the patient suffered urinary incontinence and dysuria which he found so bothersome that the gastric bladder was converted to diversion using the same gastric segment as a tube. Postoperatively there were clots of blood in stomal urine and after the kidneys had been drained intestinal fluid oozed from the stoma. On the 14th postoperative day the patient died of pulmonary embolism. The autopsy showed a perforated peptic ulcer in the gastric segment resulting in a closed fistula to the small bowel. Most probably the reason for development of the peptic ulcer was stress caused by the operation and it might have been avoided by using hydrogen-blocking agents. This case seriously questions whether a gastric segment should be used in the urinary tract at all, and at least it should never be used as a conduit.- - - - - - - - - - ranking = 5keywords = tract (Clic here for more details about this article) |
3/20. Endoscopic removal of an embedded biliary Wallstent by piecemeal extraction.Expandable metal biliary stents are reserved for patients with unresectable malignant biliary obstruction. Occasionally, these stents may cause complications necessitating removal. We describe successful endoscopic removal of a biliary Wallstent one year after insertion in a patient who initially underwent placement of an expandable metal biliary stent for presumed biliary malignancy. The stent was removed after a stent related bleeding duodenal ulcer formed.- - - - - - - - - - ranking = 4keywords = tract (Clic here for more details about this article) |
4/20. Metastatic choriocarcinoma presenting as a bleeding duodenal ulcer.We report a case of a young man with a rare disease, a choriocarcinoma of the gastrointestinal tract presenting as a common entity, a bleeding duodenal ulcer. Pathological findings and strongly positive immunostains of tissue specimens for beta human chorionic gonadotrophin confirmed the entire tumor to be a choriocarcinoma ruling out the possibility of an adenocarcinoma with focal components of choriocarcinoma or a beta human chorionic gonadotrophin producing adenocarcinoma. The pattern of tumor invasion in this case is more suggestive of metastatic than primary involvement of the gastrointestinal tract. The diagnosis of primary gastrointestinal choriocarcinoma is difficult because of the need to meticulously rule out the occurrence of a primary in other organs, which at times regresses spontaneously, a diagnosis made more difficult in this case in which no autopsy was performed.- - - - - - - - - - ranking = 29.306379421499keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
5/20. Recurrent gastric hemorrhaging with large submucosal hematomas in a patient with primary AL systemic amyloidosis: endoscopic and histopathological findings.A 64-year-old woman who suffered intractable gastric ulcers with hemorrhaging showed huge submucosal hematomas in her stomach on the endoscopic examination. Since gastric mucosal biopsy revealed amyloid deposition and IgG lambda type M protein was detectable in her serum, she was diagnosed as having primary AL systemic amyloidosis. The gastric hemorrhages did not improve despite intensive medication, so total gastrectomy was performed, resulting in an unfavorable outcome. Massive deposition of amyloid with A lambda immunoreactivity was seen on the submucosal vessels in her stomach. This is a rare primary AL systemic amyloidosis case showing recurrent and fatal gastric submucosal hematomas.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
6/20. Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis.Visual disturbance after marked and/or recurrent blood loss has been known for at least 25 centuries, since Hippocrates; however, so far its clinical features have been controversial and its pathogenesis enigmatic. The author studied seven patients, four of whom were seen soon after the visual loss and followed prospectively. A detailed review of the extensive literature and analysis of the cases provide relevant information on the subject. The blood loss is usually from the gastrointestinal (GI) tract, less often from other sites. There is typically a time lag between the bleeding and the onset of visual loss--usually up to 10 days, less often even 2 to 3 weeks. The ocular findings are typically those of anterior ischemic optic neuropathy (AION) and are usually bilateral. Considerable evidence has accumulated that blood loss, with or without arterial hypotension, causes increase in release of renin and endogenous vasoconstrictor agents (e.g., angiotensin, epinephrine, and vasopressin) because of activation of the sympathoadrenergic system and vasomotor center. Our experimental studies on renovascular malignant hypertension indicate that endogenous vasoconstrictor agents produce choroidal ischemia and AION. In view of all the evidence, it is postulated that in the production of AION after blood loss, release of endogenous vasoconstrictor agents is probably a very important factor, with arterial hypotension an additional factor; increased platelet aggregation may also play a role.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
7/20. Penetration of a gastric ulcer into the right ventricle. A complication of para-oesophageal hiatus hernia.A 74-year-old woman presented with massive upper gastro-intestinal tract bleeding that necessitated an emergency laparotomy. At operation a para-oesophageal hiatal hernia with an ulcer in the herniated fundus of the stomach penetrating the right ventricle was discovered to be the source of the bleeding. Although various complications of para-oesophageal hiatal hernias have been reported, including bleeding, this is the first reported case of ulcer penetration into the ventricle.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
8/20. Bleeding duodenal ulcer after gastric bypass procedure for obesity.A patient without previous history of peptic ulcer disease had gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity. The use of the technetium-labeled red blood cell scan helped localize the source of bleeding in this patient after routine endoscopy and barium studies failed to show any abnormality of the upper and lower gastrointestinal tracts. The patient has done well after subtotal gastrectomy for treatment of this disorder.- - - - - - - - - - ranking = 14.653189710749keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
9/20. Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract.For the purpose of arresting hemorrhage from the upper gastrointestinal tract we developed a method of endoscopic local injection of hypertonic saline-epinephrine solution, consisting of 3.6% or 7.1% sodium chloride with 0.005% epinephrine, which was locally injected around the base of the bleeding vessel under endoscopy. During the period between October 1978 and September 1983, a total of 158 patients underwent treatment for hemostasis by this method. The major causes of bleeding in our study consisted of gastric ulcers (114) and duodenal ulcers (15). The overall effective rate of hemostasis was 98.1%. By applying this method, the rate of emergency operation for patients with bleeding from the upper gastrointestinal tract was significantly reduced from 21.7% (15/69) to 0.8% (1/128).- - - - - - - - - - ranking = 87.919138264496keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
10/20. Image subtraction in acute gastrointestinal bleeding studies using 99Tcm-DTPA.99Tcm-DTPA has been evaluated in our clinical and experimental programme for the detection of acute gastrointestinal bleeding. As an adjunct to this programme, a protocol for image subtraction has been developed. The patient remains still while sequential static images I(i) (i = 1, . . ., N) are taken. They are first normalized to equal total counts and then subtracted images are produced according to the following three methods (a) I(i 1)-I(i) (b) I(i) - I(mask) (c) I(mask) - I(i) where i not equal to mask and I(mask) denotes a user-selected mask image. Method (a) demonstrates fresh bleeding and sequential movement of blood in the bowel. methods (b) and (c) demonstrate overall migration of blood and accumulated bleeding depending on the choice of the mask image.- - - - - - - - - - ranking = 6keywords = tract (Clic here for more details about this article) |
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