Lower gastrointestinal bleeding diagnostic study of choice: Difference between revisions

	Lower gastrointestinal bleeding Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Lower gastrointestinal bleeding from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Management Initial resuscitation Pharmacotherapy
Surgery Surgical Management Endoscopic Intervention
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Guidelines for Management
Case Studies
Case #1
Lower gastrointestinal bleeding diagnostic study of choice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Lower gastrointestinal bleeding diagnostic study of choice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Lower gastrointestinal bleeding diagnostic study of choice
CDC on Lower gastrointestinal bleeding diagnostic study of choice
Lower gastrointestinal bleeding diagnostic study of choice in the news
Blogs on Lower gastrointestinal bleeding diagnostic study of choice
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Lower gastrointestinal bleeding diagnostic study of choice

Newer edit →

VisualWikitext

Revision as of 16:35, 12 December 2017

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

Overview

Diagnostic Study of Choice

Colonoscopy is recommended as the first-line investigation in patients presenting with LGIB.

Advantages

The advantages of colonoscopy as an initial investigation include:

The ability to accurately locate and visualize the site of the bleeding, and the potential for therapeutic intervention.

Disadvantages

Disadvantages of colonoscopy include poor visualization in an unprepared colon.
Risk of fluid overload in the acutely ill patient receiving rapid bowel preparation.

Interpretation

The sensitivity of colonoscopy in detecting lesions such as angiodysplasia depends on good bowel preparation, and it is estimated to exceed 80%.
The sensitivity of colonoscopy in detecting bleeding lesions, however, is estimated at 48% to 90%. Therefore, a bleeding site is frequently not identified.
Despite the disadvantages, complete colonoscopy can be carried out in more than 95% of patients, and a source of bleeding can be identified by colonoscopy in 74% to 82% of patients.
There is a risk of bowel perforation with colonoscopy, especially in patients with colitis

Endoscopy

Endoscopy is the investigation of choice for ischemic colitis; however, it is not recommended to perform endoscopy in a patient with severe abdominal pain or peritonitis.
In cases in which no source of bleeding is seen on colonoscopy, esophagogastroduodenoscopy should be undertaken, as occasionally, brisk UGIB increases transit time and presents as blood per rectum.
Endoscopic evaluation of the small bowel may include a combination of endoscopic techniques, such as wireless capsule endoscopy and small bowel enteroscopy (double balloon, push or spiral enteroscopy).
These modalities are often used if colonoscopy and esophagogastroduodenoscopy have failed to identify the source of gastrointestinal blood loss
Advantages of capsule endoscopy are that it is technically easier to use, is noninvasive, and does not require sedation. However, it lacks endoscopic access for therapeutic intervention.
Capsule endoscopy has a higher diagnostic yield in bleeding patients than enteroscopy, 56% and 26% respectively, and is, therefore, often performed before enteroscopy. If a bleeding lesion is visualized, then endoscopic intervention can be considered

CTA

CTA may be a more appropriate first-line investigation in patients with abdominal pain or suspected peritonitis.

@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}}
 == Overview ==
-* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
-* '''Goal:'''
-**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
-**To describe the gold standard test for the diagnosis of [disease name].
-**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
-* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
-* Remember to create links within WikiDoc by placing <nowiki>[[square brackets]]</nowiki> around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example, if a sentence contained the phrase anterior spinal artery syndrome, the link should be to [[anterior spinal artery syndrome]] not [[anterior]] or [[artery]] or [[syndrome]].  For more information on how to create links, click [[here]].
-* Remember to follow the same format and capitalization of letters as outlined in the template below.
-* You should include the name of the disease in the first sentence of every subsection.
 == Diagnostic Study of Choice ==
+*Colonoscopy is recommended as the first-line investigation in patients presenting with LGIB.
-===== Template statements =====
+===Advantages===
-=== Gold standard/Study of choice: ===
+The advantages of colonoscopy as an initial investigation include:
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+*The ability to accurately locate and visualize the site of the bleeding, and the potential for therapeutic intervention.
-* The following result of [gold standard test] is confirmatory of [disease name]:
+===Disadvantages===
-** Result 1
+*Disadvantages of colonoscopy include poor visualization in an unprepared colon.
-** Result 2
+*Risk of fluid overload in the acutely ill patient receiving rapid bowel preparation.
-* The [name of investigation] should be performed when:
+===Interpretation===
-** The patient presented with symptoms/signs 1. 2, 3.
+*The sensitivity of colonoscopy in detecting lesions such as angiodysplasia depends on good bowel preparation, and it is estimated to exceed 80%.
-** A positive [test] is detected in the patient.
+*The sensitivity of colonoscopy in detecting bleeding lesions, however, is estimated at 48% to 90%. Therefore, a bleeding site is frequently not identified.
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+*Despite the disadvantages, complete colonoscopy can be carried out in more than 95% of patients, and a source of bleeding can be identified by colonoscopy in 74% to 82% of patients.
-* The diagnostic study of choice for [disease name] is [name of investigation].
+*There is a risk of bowel perforation with colonoscopy, especially in patients with colitis
-* There is no single diagnostic study of choice for the diagnosis of [disease name].
+==Endoscopy==
-* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
+*Endoscopy is the investigation of choice for ischemic colitis; however, it is not recommended to perform endoscopy in a patient with severe abdominal pain or peritonitis.
-* [Disease name] is mainly diagnosed based on clinical presentation.
+*In cases in which no source of bleeding is seen on colonoscopy, esophagogastroduodenoscopy should be undertaken, as occasionally, brisk UGIB increases transit time and presents as blood per rectum.
-* Investigations:
+*Endoscopic evaluation of the small bowel may include a combination of endoscopic techniques, such as wireless capsule endoscopy and small bowel enteroscopy (double balloon, push or spiral enteroscopy).
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
+*These modalities are often used if colonoscopy and esophagogastroduodenoscopy have failed to identify the source of gastrointestinal blood loss
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
+*Advantages of capsule endoscopy are that it is technically easier to use, is noninvasive, and does not require sedation. However, it lacks endoscopic access for therapeutic intervention.
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
+*Capsule endoscopy has a higher diagnostic yield in bleeding patients than enteroscopy, 56% and 26% respectively, and is, therefore, often performed before enteroscopy. If a bleeding lesion is visualized, then endoscopic intervention can be considered
+==CTA==
-==== The comparison table for diagnostic studies of choice for [disease name] ====
+*CTA may be a more appropriate first-line investigation in patients with abdominal pain or suspected peritonitis.
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
-|}
-<small> ✔= The best test based on the feature </small>
-===== Diagnostic results =====
-The following result of [investigation name] is confirmatory of [disease name]:
-* Result 1
-* Result 2
-===== Sequence of Diagnostic Studies =====
-The [name of investigation] should be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-=== Diagnostic Criteria ===
-* Here you should describe the details of the diagnostic criteria.
-*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
-*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
-*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
-*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
-*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
-*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-** Criteria 1
-** Criteria 2
-** Criteria 3
-IF there are clear, established diagnostic criteria:
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-IF there are no established diagnostic criteria:
-*There are no established criteria for the diagnosis of [disease name].
 ==References==
-* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
+{{reflist|2}}
-* For information on how to add references into your page, click [[Adding References to Articles|here]].

Lower gastrointestinal bleeding diagnostic study of choice: Difference between revisions

Revision as of 16:35, 12 December 2017

Overview

Diagnostic Study of Choice

Advantages

Disadvantages

Interpretation

Endoscopy

CTA

References

Navigation menu

Search