Primary non-specific ulcer of the small bowel.
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Abstract:
A case is presented of lifelong bleeding from an ileal ulcer in a 17-year-old female. This diagnostic possibility should be suspected in gastrointestinal hemorrhage when no commoner localization of the bleeding can be found.Keywords:
Obscure Gastrointestinal Bleeding
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We investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988–92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patients were included in the study: duodenal ulcer, 202; hemorrhagic gastritis 108; gastric ulcer 101; duodenal ulcer and hemorrhagic gastritis 12; and duodenal ulcer and gastric ulcer, 10. The highest incidence of bleeding was observed during winter (31.7%) and spring (28.3%), progressively diminishing throughout summer (18.5%) and fall (21.5%) (p < 0.0001). Both females and males showed this significant seasonal variation (p < 0.025 and p < 0.005, respectively). As a group, patients over 57 years of age had the highest incidence of bleeding during winter and spring (p < 0.005). Interestingly, the ingestion of NSAID had no influence in the increased seasonal bleeding. Duodenal ulcer (p < 0.01) and hemorrhagic gastritis (p < 0.05) showed a significant seasonal variation while gastric ulcer did not. Although there are several reports in the literature concerning seasonal fluctuations in duodenal and gastric ulcers, no such studies have hitherto been published on hemorrhagic gastritis.
Gastrointestinal bleeding
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Medical record
Internal hernia
Gastrointestinal function
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Henoch-Schönlein purpura (HSP) is the most common form of systemic vasculitis in children. Palpable purpura, arthralgia, arthritis, abdominal pain and renal involvement are the major clinical manifestations. Gastrointestinal involvement is related with abdominal pain and bleeding. We described a 71 year-old female experienced acute exacerbation of HSP presented with gastrointestinal bleeding. She was hospitalized for hematemesis and diagnosed duodenitis by esophagogastroduonenoscopy (EGD). Duodenitis was improved at EGD checked in 7 days. She still complained of melena and abdominal pain. There were no abnormal findings at sigmoidoscopy. Jejunal ulcer and purpura were diagnosed by capsule endoscopy. Symptoms were relieved after administration of systemic steroid. But she needed renal replacement therapy for 3 months. Small bowel ulcer diagnosed by capsule endoscopy in patients with HSP was rarely described in Korean literature. This case suggests that capsule endoscopy have a role in diagnosis of small bowel ulcer and its severity in HSP with gastrointestinal symptom.
Melena
Duodenitis
Purpura (gastropod)
Gastrointestinal bleeding
Sigmoidoscopy
Enteroscopy
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Objective To investigate the efficacy of recombinant activated factor Ⅶ (γFⅦa)in the management or prevention of intraoporative bleeding in general surgery. Methods A retrospective analysis was made to investigate the effect of FⅦa in 56 surgical cases.There were 56 cases including 53 hepatobiliary cases,3 gastrointestinal surgical cflses.γFⅦa was used intraoperatively when bleeding was difficult to control in 12 patients,and in 30 liver transplant cases before a skin incision was made.γFⅦa was used in the other 14 cases postoperatively to control intraabdominal bleeding. Results Massive bleeding stopped in 11 out of 12 cases who used γFⅦa during the operation as a rescue regimen,though two of them eventually died intraoperatively for deteriorating hemedynamics,one died of intraoperative intractable bleeding in spite of the Use of γFⅦa.All the 30 liver transplant cases used γFⅦa in the prevention of intraoperative bleeding had a successful surgery.After γFⅦa was administered in 11 out of the 14 cases of postoperative bleeding,the drainage decreased by 50%.In 3 cases γFⅦa failed and hemodynamic and vital signs were still unstable.In brief,γFⅦa were safely used in bleeding control or prophylaxis.Its Successful rate reached 89% in 56 patients.No thrombus complication was found. Conclusion γFⅦ a controls perioperative hemorrhage complications.
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Factor Ⅶa; Blood loss,surgical
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Gastrointestinal bleeding
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Abstract In a nine-year period from 1977 to 1985 sixty-one patients underwent surgery for bleeding gastric ulceration in the Western Infirmary, Glasgow. Nineteen patients were treated by partial gastrectomy, twenty-two had undersewing of the ulcer plus vagotomy and drainage and twenty had undersewing alone. Mortality in the three groups was 26, 45 and 10 per cent respectively. All groups of patients were similar in terms of age, severity of haemorrhage, delay before surgery and grade of surgeon performing the procedure. Out-patient follow-up (mean: 37 months) of patients treated by undersewing alone revealed that 73 per cent were symptom free. Treatment of bleeding gastric ulceration by undersewing alone is effective and should be considered in patients who require surgery.
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Obscure Gastrointestinal Bleeding
Mucosal lesions
Radiation Enteritis
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Objective of the investigation was to examine clinical characteristics of peptic duodenal ulcer (DU) associated with arterial hypertension (АH) after acute gastrointestinal bleeding (AGB). The study included 25 patients with AH associated with DU, 45 patients with AH in AGB, 63 patients with AGB without AH, 48 patients with AH without AGB and 69 patients with DU without AH. If AH joins the existing DU, it increases the intensity of pain and dyspeptic syndromes. If DU joins AH, on the other hand, the clinical picture of ulcer disease was unclear. The largest concentration of Helicobacter pylori antibodies was found in patients with AH in AGB. Hypertensive crises were detected more often in combination of AH and DU.
Peptic
Gastrointestinal bleeding
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To determine whether severity of Helicobacter pylori (H. pylori) infection is aggravated during acute duodenal ulcer bleeding and related to bleeding severity.One hundred and thirty-eight patients with H. pylori-infected bleeding duodenal ulcer and 112 non-bleeding cases were included in the study. A comparison was made of the anti-H. pylori IgG titer, endoscopic finding, density of H. pylori (range: 1-5) in the antrum, and severity of antral gastritis (score: 0-3) between bleeding and non-bleeding cases. The role of H. pylori in bleeding cases was further analyzed to survey its relationship to the severity of bleeding judged by clinical parameters. The H. pylori status of patients with rebleeding within the first week was compared to that of the non-rebleeding cases as well.The anti-H. pylori IgG titer and H. pylori density of the non-bleeding group were lower than those of the bleeding group (0.466+/-0.288 vs. 0.912+/-0.559, p<0.001; 2.13+/-1.02 vs. 3.34+/-1.32, p<0.001). The percentages of bleeding ulcers in the study cases increased in a trend as the density of H. pylori increased (density: 1-5; 32.7%, 33.8%, 57.4%, 81.3%, 91.4%, p<0.001). Although the severity of gastritis and density of H. pylori disclosed an upward trend as bleeding severity increased, only ulcer size was significantly associated with bleeding severity (p<0.05). The 10 cases with recurrent bleeding had higher bacterial density and serological titer than the 128 non-rebleeding cases (p<0.005).Heavy bacterial loads of H. pylori infection may precipitate bleeding episodes of duodenal ulcer. However, in bleeding duodenal ulcer, the status of H. pylori infection is not strongly associated with initial bleeding severity before therapeutic endoscopy. With the aim of enhancing hemostasis and preventing rebleeding, further studies could focus on diminishing the bacterial load of H. pylori during bleeding episodes.
Gastrointestinal bleeding
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Objective To investigate the risk factors for upper gastrointestinal bleeding in patients with gastric or duodenal ulcer.Methods The study included 178 cases(male 115,female 63)of patients with duodenal or gastric ulcer diagnosed by upper gastrointestinal endoscopy in our hospital.All patients were treated by non-steroidal anti-inflammatory drugs(NSAIDs)or acetylsalicylic acid(ASA),risk factors such as coronary artery disease(CAD),age and gender were assessed through the chi-square test and logistic regression analysis.Results 47 cases of patients was diagnosed as gastric or duodenal ulcer bleeding,with an average age of 65.7±12.5 years old,no bleeding patients with an average age of 46.8±15.0 years old.ASA usage were more common than NSAID in bleeding patients(NSAIDs n=18;the ASA n=26 cases,P=0.036).In gastric ulcer patients,the proportion of bleeding in women was 20% and in men was 28%(P=0.056).Ulcer bleeding risk factors were CAD(OR:24.66,95% CI=1.7-95.8,P=0.002),ASA usage(OR:9.67,95% CI=2.2-36.6,P=0.022),NSAID usage(OR:4.63 95% CI=1.2-15.6,P=0.033),age(OR=11.50,95% CI=2.8-11.2,P=0.002),male(OR:2.47,95% CI=0.9-8.7,P=0.053).Conclusion Old age,atherosclerosis,male and non-steroidal anti-inflammatory drugs and acetyl salicylic acid usage was the major risk factors for upper gastrointestinal bleeding in the gastric and duodenal ulcer patients,the use of acetylsalicylic acid was the highest risk of gastrointestinal bleeding in patients with gastric and duodenal ulcers.
Gastrointestinal bleeding
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