UMEM Educational Pearls - Gastrointestional

Category: Gastrointestional

Title: Volvulus Quick Facts

Keywords: Volvulus, Cause, (PubMed Search)

Posted: 11/17/2007 by Michael Bond, MD (Updated: 7/16/2024)
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Volvulus Quick Facts

Volvulus causes 10-15% of large bowel obstructions and occurs most commonly in the elderly.
The most common type of volvulus is sigmoid volvulus.
Midgut volvulus is most common in the neonatal period.
Cecal volvulus:
- Occurs in all ages, but most commonly in the 25- to 35-year-old age group
- Associated with:
  - previous abdominal surgeries
  - young, healthy marathon runners.
Sigmoid volvulus most commonly occurs in two groups of individuals:
- Inactive elderly persons with a history of severe chronic constipation
- Patients with severe psychiatric or neurologic disease.

Category: Gastrointestional

Title: Gastrointestional Bleeding

Keywords: Gi Bleed, Diveriticular, Bleed, (PubMed Search)

Posted: 9/22/2007 by Michael Bond, MD (Updated: 7/16/2024)
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Gastrointestional Bleeding Pearls. [Quick Facts]

Peptic ulcer disease has 2 main etiologies: 1) Helicobacter pylorus infection and 2) NSAID use. Zollinger Ellison Syndrome causes 1% of peptic ulcer disease.
Hemorrhage is the most common complication of peptic ulcer disease, occurring in 15% of patients
25% of patients over the age of 60 years have an AV malformation.
The most common cause of significant lower GI bleeding in the elderly is diverticulosis or angiodysplasia. That typically presents as painless bright red rectal bleeding.
AV malformations are the number 2 cause of massive lower gastrointestinal hemorrhage.
Rectal bleeding following AAA repair is from aortoenteric fistula until proven otherwise.

Category: Gastrointestional

Title: Medical Management of Upper GI Bleeds

Keywords: Peptic Ulcer Disease, Omeprazole, Bleeding (PubMed Search)

Posted: 8/19/2007 by Michael Bond, MD (Updated: 7/16/2024)
Click here to contact Michael Bond, MD

Medical Management of Upper GI bleeds. Peptic Ulcer Disease: Proton pump inhibitors are the main stay of therapy. Use is based on the observation that pH over 6 is required for platelet aggregation whereas pH below 5 results in clot lysis. High dose IV therapy should be reserved with those that have high risk stigmata of rebleeding as seen on endoscopy. Regular dose IV or PO omeprazole can be used in most patients. Variceal Bleeding: Consider octreatide (50 mcg bolus followed by 50 mcg/hr IV) and non-selective beta blocker therapy to reduce bleeding. Human recombinant activated factor VII has gotten a lot of press lately though it did not reduce the risk of death at either 5 or 42 days in patients with liver related GI bleeds.A Wong T. The management of upper gastrointestinal haemorrhage. [Review] [31 refs] [Journal Article. Review] Clinical Medicine. 6(5):460-4, 2006 Sep-Oct. Marti-Carvajal AJ. Salanti G. Marti-Carvajal PI. Human recombinant activated factor VII for upper gastrointestinal bleeding in patients with liver diseases. [Review] [45 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (1):CD004887, 2007. Martins NB. Wassef W. Upper gastrointestinal bleeding. [Review] [87 refs] [Journal Article. Review] Current Opinion in Gastroenterology. 22(6):612-9, 2006 Nov.