Lower gastrointestinal bleeding other diagnostic studies: Difference between revisions

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Latest revision as of 20:54, 14 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Nasogastric tube lavage may be helpful in the diagnosis of lower gastrointestinal bleeding. NGT helps in differentiating LGIB from UGIB. 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.

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 brown colored or 'coffee ground coloured blood documents presence of UGIB.
Evidence of bilious material rules out bleeding distal to the pylorus.
Aspiration of any other GI contents is non-diagnostic.
After the NGT lavage it's often difficult to determine whether blood in gastric contents is either vomited or from aspiration.
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 documented the following results:

Determining whether blood is in the gastric aspirate^[4]
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.

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[pmid22032314-1] 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.

[pmid6978482-2] Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.

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[2]

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@@ Line 5: / Line 5: @@
 ==Overview==
-Nasogastric tube lavage may be helpful in the diagnosis of lower gastrointestinal bleeding. NGT helps in differentiating LGIB from UGIB. 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.
+[[Nasogastric aspiration|Nasogastric tube lavage]] may be helpful in the diagnosis of lower gastrointestinal bleeding. NGT helps in differentiating [[Lower gastrointestinal bleeding|LGIB]] from [[Upper gastrointestinal bleeding|UGIB]]. Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of [[Upper gastrointestinal bleeding|UGIB]]. Evidence of [[bilious]] material rules out bleeding distal to the pylorus.
 ==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>
+*Nasogastric lavage is only indicated when the diagnosis of [[Upper gastrointestinal bleeding|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.
+*Nasogastric lavage also helps in documenting active or recent [[Upper gastrointestinal bleeding|UGIB]] and the need for urgent [[endoscopy]].
-*Occasionally used to empty gastric contents in preparation for 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 brown colored or 'coffee ground coloured blood documents presence of [[Upper gastrointestinal bleeding|UGIB]].
-*Evidence of bilious material rules out bleeding distal to the pylorus.
+*Evidence of bilious material rules out bleeding distal to the [[pylorus]].
-*Any other appearances of GI contents are non-diagnostic.
+*Aspiration of any other GI contents is non-diagnostic.
-*There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome.
+*After the NGT lavage it's often difficult to determine whether [[blood]] in gastric contents is either vomited or from [[aspiration]].
-*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:
+*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 documented the following results:
 {| class="wikitable" style="text-align:center"
 |+ Determining whether blood is in the gastric aspirate{{ref|4}}
@@ Line 34: / Line 33: @@
 ====Contraindications====
-*Avoid gastric lavage in patients with suspected perforated abdominal viscus.
+*Avoid gastric lavage in patients with suspected [[Perforation peritonitis|perforated abdominal viscus.]]
 ====Complicatiions====
 Complications of the procedure include:
-*Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication.
+*Bleeding from [[trauma]] during tube passage in patients with [[coagulopathy]] is a possible complication.
 *Other rare complications include
-**Pharyngeal and esophageal perforation
+**[[Perforation|Pharyngeal and esophageal perforation]]
-**Cardiac arrest
+**[[Cardiac arrest]]
 **Ethmoid sinus fracture with brain trauma
 **Bronchial intubation.