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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Lower GI Series: Barium Enema01:23

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A Barium Enema, or a lower GI series, is a specialized radiographic examination designed to visualize the lower gastrointestinal tract, specifically the colon and rectum. This procedure is instrumental in diagnosing various conditions such as colorectal cancer, polyps, diverticulosis, and inflammatory bowel disease.
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
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Gastritis III: Clinical Manifestations and Management01:23

Gastritis III: Clinical Manifestations and Management

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The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
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Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
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Peptic Ulcer Disease IV: Management01:26

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Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
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Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
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Evaluation and Management of Lower GI Bleeding.

Melissa K Drezdzon1, Kent J Peterson

  • 1Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

Diseases of the Colon and Rectum
|March 22, 2022
PubMed
Summary

A patient on apixaban experienced severe gastrointestinal bleeding. Surgical colectomy successfully treated the bleeding, which was linked to colonic polyps.

Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Pharmacology

Background:

  • Anticoagulation therapy with apixaban is common for preventing thromboembolic events.
  • Gastrointestinal bleeding is a potential complication of anticoagulation.
  • Identifying the source of obscure gastrointestinal bleeding can be challenging.

Observation:

  • A 73-year-old woman on apixaban presented with hypotension and hematochezia.
  • Initial endoscopic evaluation did not reveal active bleeding.
  • CT angiography identified extravasation in the transverse colon, guiding surgical intervention.

Findings:

  • Segmental transverse colectomy was performed due to persistent bleeding and hemodynamic instability.
  • Surgical pathology revealed multiple adenomas without dysplasia as the likely source.

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  • The patient experienced complete resolution of gastrointestinal bleeding post-operatively.

    • Implications:

    • This case highlights the importance of advanced imaging in diagnosing obscure gastrointestinal bleeding in patients on anticoagulation.
    • Surgical resection can be a definitive treatment for anticoagulation-related gastrointestinal hemorrhage.
    • Understanding the potential for polyp-associated bleeding, even without dysplasia, is crucial in managing anticoagulated patients.