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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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Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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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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Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies01:28

Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies

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Peptic ulcer disease (PUD) presents with diverse symptoms depending on the location and severity of the ulcer. Clinical manifestations of peptic ulcer include dull pain and a burning sensation in the mid-epigastric region.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
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Peptic Ulcer Disease IV: Management01:26

Peptic Ulcer Disease IV: Management

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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.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
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Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

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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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ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding: 2024 Update.

, Prashant Nagpal1, Bari Dane2

  • 1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Journal of the American College of Radiology : JACR
|November 2, 2024
PubMed
Summary

This study guides initial imaging selection for nonvariceal upper gastrointestinal bleeding (UGIB) across five clinical scenarios. It rates imaging modality appropriateness to aid clinicians in choosing the best diagnostic approach for UGIB patients.

Keywords:
AUCAppropriateness CriteriaCT angiographyappropriate use criteriaimagingnonvariceal bleedingoccult gastrointestinal bleedingupper gastrointestinal bleeding (UGIB)

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Area of Science:

  • Radiology
  • Gastroenterology

Background:

  • Nonvariceal upper gastrointestinal bleeding (UGIB) management requires careful diagnostic planning.
  • Selecting appropriate initial imaging is crucial for effective patient care and resource utilization.

Purpose of the Study:

  • To summarize literature and provide evidence-based recommendations for initial imaging in five distinct clinical scenarios of nonvariceal UGIB.
  • To guide the selection of the most appropriate imaging modality based on clinical presentation and endoscopic findings.

Main Methods:

  • Systematic analysis of peer-reviewed medical literature.
  • Application of the RAND/UCLA Appropriateness Method, incorporating GRADE principles.
  • Expert panel review and consensus for evidence gaps.

Main Results:

  • Appropriateness ratings (usually appropriate, may be appropriate, usually not appropriate) were assigned to various imaging modalities for each of the five clinical scenarios.
  • Guidelines were developed to assist in selecting the optimal initial imaging strategy for nonvariceal UGIB.

Conclusions:

  • This evidence-based guideline assists clinicians in selecting appropriate initial imaging for nonvariceal UGIB.
  • The recommendations aim to optimize diagnostic pathways and improve outcomes in patients with upper gastrointestinal bleeding.