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Aditya Ganti (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
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Aditya Ganti (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
11,402 edits
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__NOTOC__
__NOTOC__
{{CMG}}
{{CMG}}
==Overview==
==Overview==
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* Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
* Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
* Surgery should be reserved for symptomatic FNH lesion.
* Surgery should be reserved for symptomatic FNH lesion.
{| class="wikitable"
! colspan="2" |Parasitic Infection
!Mode of infection
!Epidemiology
!'''Clinical manifestations''' 
! colspan="2" |Diagnosis
!Treatment
|-
!Disease
!Parasite
!
!
!
!'''Laboratory findings''' 
!Imaging
!
|-
|Ascariasis
|
|
|
|
|
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|
|-
|Necatoriasis
|
|
|
|
|
|
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|-
|Giardiaisis
|
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|
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|-
| Fasciolosis 
|
|
|
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|-
|Schistosomiasis
|
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|-
|Strongyloidiasis
|
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|-
|Amoebiais
|
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|-
|Taeniasis
|
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|-
|Trichuriasis
|
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|-
|Hymenolepiasis
|''Hymenolepis nana''
|Ingestion of infected eggs
|Most common in temperate zones
* South Europe
* Russia
* India
* US
* Latin America.
|
* Asymptomatic<ref name="pmid26535513">{{cite journal| author=Muehlenbachs A, Bhatnagar J, Agudelo CA, Hidron A, Eberhard ML, Mathison BA et al.| title=Malignant Transformation of Hymenolepis nana in a Human Host. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 19 | pages= 1845-52 | pmid=26535513 | doi=10.1056/NEJMoa1505892 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26535513  }}</ref>
* Heavy infections with >1000 worms can occur
** Crampy [[abdominal pain]]
** Diarrhea
** Anorexia
** Fatigue
** Pruritus ani
|
* Stool microscopy
** FLOTAC method
|
|
* [[Praziquantel]]
* Prompt family screening or empiric treatment
|}

Revision as of 15:36, 1 March 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Lower gastrointestinal bleeding, commonly abbreviated LGIB, refers to any form of bleeding in the lower gastrointestinal tract.

Causes

Diagnosis

The following suggest an LGIB:

The following may suggest an LGIB:

Related Chapter

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blood in stools
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abdominal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fever
 
 
 
 
 
 
Rectal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H/O of constipation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H/O of constipation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Weightloss
 
 
 
 
 
Diverticulosis
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamic status
 
 
 
 
 
 
Diverticulitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stable
 
 
 
 
 
Unstable
 
 
 
 
 
 
 
 
Polyps
 
 
 
 
 
Colon cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Weight Loss
 
 
 
 
 
 
Anal fissure
External Hemmrhoids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rectal cancer
Colon cancer
 
 
 
 
 
 
 
Angiodysplasia
Polyps

Management

Hepatic adenoma

Management of hepatic adenoma depends upon:

  • Symptoms
  • Size
  • Number
  • Location
  • Certainty of the diagnosis

Asymptomatic woman on OCPs with a small adenoma

The European Association for Study of the Liver recommends

  • Discontinuation of contraceptive medication
  • Close observation of the lesion with repeated imaging and alpha fetoprotein.
    • Contrast-enhanced magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
  • Patients with hepatic adenomas that do not resolve or that enlarge after six months of observation should undergo treatment.

Symptomatic patients and those with large adenomas

  • Surgical resection is recommended for all symptomatic patients with hepatic adenoma and those with large lesions (>5 cm).
  • Surgical options include :
    • Enucleation
    • Resection
    • Liver transplantation
  • Nonsurgical interventions include
    • Transarterial embolization
    • Radiofrequency ablation

Hepatic Hemangioma

  • Asymptomatic patients
    • Patients with lesions <1.5 cm, are reassured and observed.
    • Follow-up imaging in patients with hemangiomas ≤5 cm in size is usually not recommended.
    • Patients with rapid growth of a hemangioma or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
    • It is recommended not perform additional imaging if there is no change in the size of the lesion.  
  • Symptomatic patients
    • Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
    • Surgical options include 
      • Liver resection
      • Enucleation
      • Hepatic artery ligation
      • Liver transplantation
    • Non-surgical techniques include
      • Hepatic artery embolization
      • Radiotherapy
      • Interferon alfa-2a 

Focal nodular hyperplasia

  • Due to their benign nature of focal nodular hyperplasia, there is
  • Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
  • Surgery should be reserved for symptomatic FNH lesion.
Parasitic Infection Mode of infection Epidemiology Clinical manifestations  Diagnosis Treatment
Disease Parasite Laboratory findings  Imaging
Ascariasis
Necatoriasis
Giardiaisis
 Fasciolosis 
Schistosomiasis
Strongyloidiasis
Amoebiais
Taeniasis
Trichuriasis
Hymenolepiasis Hymenolepis nana Ingestion of infected eggs Most common in temperate zones
  • South Europe
  • Russia
  • India
  • US
  • Latin America.
  • Asymptomatic[1]
  • Heavy infections with >1000 worms can occur
  • Stool microscopy
    • FLOTAC method
  1. ↑ Muehlenbachs A, Bhatnagar J, Agudelo CA, Hidron A, Eberhard ML, Mathison BA; et al. (2015). "Malignant Transformation of Hymenolepis nana in a Human Host". N Engl J Med. 373 (19): 1845–52. doi:10.1056/NEJMoa1505892. PMID 26535513.
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