Lower gastrointestinal bleeding other diagnostic studies: Difference between revisions
Jump to navigation
Jump to search
Aditya Ganti (talk | contribs) No edit summary |
Aditya Ganti (talk | contribs) |
||
| Line 7: | Line 7: | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
===Nasogastric lavage=== | |||
*Nasogastric lavage is only indicated when the diagnosis of UGIB doubtful.<ref name="pmid22032314">{{cite journal |vauthors=Pallin DJ, Saltzman JR |title=Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated? |journal=Gastrointest. Endosc. |volume=74 |issue=5 |pages=981–4 |year=2011 |pmid=22032314 |doi=10.1016/j.gie.2011.07.007 |url=}}</ref><ref name="pmid6978482">{{cite journal |vauthors=Marshall JB |title=Management of acute upper gastrointestinal bleeding |journal=Postgrad Med |volume=71 |issue=5 |pages=149–54, 157–8 |year=1982 |pmid=6978482 |doi= |url=}}</ref> | |||
*It is rarely used. | |||
*Nasogastric lavage also helps in documenting active or recent UGIB and the need for urgent endoscopy. | |||
*Occasionally used to empty gastric contents in preparation for endoscopy. | |||
====Interpretation==== | |||
*Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of UGIB. | |||
*Evidence of bilious material rules out bleeding distal to the pylorus. | |||
*Any other appearances of GI contents are non-diagnostic. | |||
*There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome. | |||
*Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult. | |||
*Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult). | |||
*Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate{{ref|5}}. Cuellar found the following results: | |||
{| class="wikitable" style="text-align:center" | |||
|+ Determining whether blood is in the gastric aspirate{{ref|4}} | |||
! Finding !! Sensitivity !! Specificity !! Positive predictive value<br>(prevalence of 39%)!! Negative predictive value<br>(prevalence of 39%) | |||
|- | |||
! Gastroccult | |||
| 95% || 82% || 77% || 96% | |||
|- | |||
! Physician assessment | |||
| 79% || 55% || 53% || 20% | |||
|} | |||
*Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate{{ref|6}}. | |||
====Contraindications==== | |||
*Avoid gastric lavage in patients with suspected perforated abdominal viscus. | |||
====Complicatiions==== | |||
Complications of the procedure include: | |||
*Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication. | |||
*Other rare complications include | |||
**Pharyngeal and esophageal perforation | |||
**Cardiac arrest | |||
**Ethmoid sinus fracture with brain trauma | |||
**Bronchial intubation. | |||
==References== | ==References== | ||
Revision as of 17:07, 12 December 2017
|
Lower gastrointestinal bleeding Microchapters |
|
Differentiating Lower gastrointestinal bleeding from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Management |
|
Surgery |
|
Case Studies |
|
Lower gastrointestinal bleeding other diagnostic studies On the Web |
|
American Roentgen Ray Society Images of Lower gastrointestinal bleeding other diagnostic studies |
|
FDA on Lower gastrointestinal bleeding other diagnostic studies |
|
CDC on Lower gastrointestinal bleeding other diagnostic studies |
|
Lower gastrointestinal bleeding other diagnostic studies in the news |
|
Blogs on Lower gastrointestinal bleeding other diagnostic studies |
|
Risk calculators and risk factors for Lower gastrointestinal bleeding other diagnostic studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Other Imaging Findings
Nasogastric lavage
- Nasogastric lavage is only indicated when the diagnosis of UGIB doubtful.[1][2]
- It is rarely used.
- Nasogastric lavage also helps in documenting active or recent UGIB and the need for urgent endoscopy.
- Occasionally used to empty gastric contents in preparation for endoscopy.
Interpretation
- Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of UGIB.
- Evidence of bilious material rules out bleeding distal to the pylorus.
- Any other appearances of GI contents are non-diagnostic.
- There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome.
- Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult.
- Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult).
- Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate[3]. Cuellar found the following results:
| Finding | Sensitivity | Specificity | Positive predictive value (prevalence of 39%) |
Negative predictive value (prevalence of 39%) |
|---|---|---|---|---|
| Gastroccult | 95% | 82% | 77% | 96% |
| Physician assessment | 79% | 55% | 53% | 20% |
- Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate[5].
Contraindications
- Avoid gastric lavage in patients with suspected perforated abdominal viscus.
Complicatiions
Complications of the procedure include:
- Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication.
- Other rare complications include
- Pharyngeal and esophageal perforation
- Cardiac arrest
- Ethmoid sinus fracture with brain trauma
- Bronchial intubation.
References
- ↑ Pallin DJ, Saltzman JR (2011). "Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated?". Gastrointest. Endosc. 74 (5): 981–4. doi:10.1016/j.gie.2011.07.007. PMID 22032314.
- ↑ Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.