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Emergencies and Complications in Gastroenterology - part 3

Tham khảo tài liệu 'emergencies and complications in gastroenterology - part 3', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | General Aspects of Lower Gastrointestinal Bleeding The incidence of lower gastrointestinal bleeding is only one fifth of that of the upper gastrointestinal tract and is estimated to be 21-27 cases per 100 000 adults year 4 5 . LGIB usually is chronic and self-limiting and can be treated on an outpatient basis. Nevertheless 21 of 100 000 adults year require hospitalization due to severe bleeding. Among those male gender and older patients suffer from more severe LGIB 4 . There is a 200-fold increase from the third to the ninth decade due to diver-ticulosis and angiodysplasia 6 . There is some evidence that upper gastrointestinal bleeding UGIB differs in acuity and severity from LGIB Patients with LGIB are significantly less in shock 19 vs. 35 respectively require fewer blood transfusions 36 vs. 64 and have a significantly higher hemoglobin level 84 vs. 61 7 8 . Similar to UgIB the majority of bleeding disorders 80-85 in the lower gastrointestinal tract will stop spontaneously. Mortality and morbidity increase with age. The overall mortality rate varies between 2.0 and 3.6 . Those patients with bleeding episodes after hospital admission have significantly higher mortality rates 23.1 compared to those who bleed before hospital admission 4 . Diagnosis Endoscopy is the method of choice to diagnose and if possible to treat lower gastrointestinal bleeding. While colonoscopy has been accepted for years in patients with chronic bleeding urgent colonoscopy in acute bleeding has been evaluated in the last few years and is meanwhile also accepted as a safe method. Before starting colonoscopy history and clinical examination should lead to a tentative diagnosis in order to plan the diagnostic procedures. In patients with chronic LGIB colonoscopy is the first diagnostic step. The time point of colonoscopy is elective and optimal bowel preparation is standard. If the origin of bleeding cannot be detected further steps are necessary. In contrast patients with acute LGIB are a .