Sandbox spinalcord
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
- Coagulopathy - specifically a bleeding diathesis
- Colitis
- Hemorrhoids
- Angiodysplasia
- Neoplasm - cancer
- Diverticular disease - diverticulosis, diverticulitis
Diagnosis
The following suggest an LGIB:
- Melena and a negative oesophagogastroduodenoscopy
- Hematochezia
- Fecal occult blood
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 | ||
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Disease | Parasite | Incidence | Geographic distrubution | ||||
Ascariasis | Ascaris lumbricoides |
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Necatoriasis | Necator americanus |
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Giardiasis | Giardia lamblia |
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Fasciolosis | Fasciola Hepaticum |
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Schistosomiasis |
Infection can occur by:
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Sub-Saharan Africa.[19] | Acute schistosomiasis syndrome [20] |
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Strongyloidiasis | Strongyloidis Stercoralis |
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Amoebiais | E. Histolytica |
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Taeniasis |
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Trichuriasis | Trichuris trichiura |
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Hymenolepiasis | Hymenolepis nana |
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Most common in temperate zones[41]
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- ↑ Permin A, Henningsen E, Murrell KD, Roepstorff A, Nansen P (2000). "Pigs become infected after ingestion of livers and lungs from chickens infected with Ascaris of pig origin". Int J Parasitol. 30 (7): 867–8. PMID 10899534.
- ↑ Betson M, Nejsum P, Bendall RP, Deb RM, Stothard JR (2014). "Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs". J Infect Dis. 210 (6): 932–41. doi:10.1093/infdis/jiu193. PMC 4136802. PMID 24688073.
- ↑ Bradbury RS, Hii SF, Harrington H, Speare R, Traub R (2017). "Ancylostoma ceylanicum Hookworm in the Solomon Islands". Emerg Infect Dis. 23 (2): 252–257. doi:10.3201/eid2302.160822. PMC 5324822. PMID 28098526.
- ↑ Nawalinski TA, Schad GA (1974). "Arrested development in Ancylostoma duodenale: course of a self-induced infection in man". Am J Trop Med Hyg. 23 (5): 895–8. PMID 4451228.
- ↑ Chhabra P, Bhasin DK (2017). "Hookworm-Induced Obscure Overt Gastrointestinal Bleeding". Clin Gastroenterol Hepatol. 15 (11): e161–e162. doi:10.1016/j.cgh.2017.02.034. PMID 28300694.
- ↑ McKenna ML, McAtee S, Bryan PE, Jeun R, Ward T, Kraus J; et al. (2017). "Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama". Am J Trop Med Hyg. 97 (5): 1623–1628. doi:10.4269/ajtmh.17-0396. PMID 29016326.
- ↑ Genta RM, Woods KL (1991). "Endoscopic diagnosis of hookworm infection". Gastrointest Endosc. 37 (4): 476–8. PMID 1916173.
- ↑ Serre-Delcor N, Treviño B, Monge B, Salvador F, Torrus D, Gutiérrez-Gutiérrez B; et al. (2017). "Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI". Enferm Infecc Microbiol Clin. 35 (10): 617–623. doi:10.1016/j.eimc.2016.02.024. PMID 27032297.
- ↑ Quick R, Paugh K, Addiss D, Kobayashi J, Baron R (1992). "Restaurant-associated outbreak of giardiasis". J Infect Dis. 166 (3): 673–6. PMID 1500757.
- ↑ Muhsen K, Levine MM (2012). "A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries". Clin Infect Dis. 55 Suppl 4: S271–93. doi:10.1093/cid/cis762. PMC 3502312. PMID 23169940.
- ↑ Pickering LK, Woodward WE, DuPont HL, Sullivan P (1984). "Occurrence of Giardia lamblia in children in day care centers". J Pediatr. 104 (4): 522–6. PMID 6707812.
- ↑ Lengerich EJ, Addiss DG, Juranek DD (1994). "Severe giardiasis in the United States". Clin Infect Dis. 18 (5): 760–3. PMID 8075266.
- ↑ Claas EC, Burnham CA, Mazzulli T, Templeton K, Topin F (2013). "Performance of the xTAG® gastrointestinal pathogen panel, a multiplex molecular assay for simultaneous detection of bacterial, viral, and parasitic causes of infectious gastroenteritis". J Microbiol Biotechnol. 23 (7): 1041–5. PMID 23711521.
- ↑ Fung HB, Doan TL (2005). "Tinidazole: a nitroimidazole antiprotozoal agent". Clin Ther. 27 (12): 1859–84. doi:10.1016/j.clinthera.2005.12.012. PMID 16507373.
- ↑ Chan CW, Lam SK (1987). "Diseases caused by liver flukes and cholangiocarcinoma". Baillieres Clin Gastroenterol. 1 (2): 297–318. PMID 2822181.
- ↑ Marcos LA, Terashima A, Gotuzzo E (2008). "Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis". Curr Opin Infect Dis. 21 (5): 523–30. doi:10.1097/QCO.0b013e32830f9818. PMID 18725803.
- ↑ Prociv P, Walker JC, Whitby M (1992). "Human ectopic fascioliasis in Australia: first case reports". Med J Aust. 156 (5): 349–51. PMID 1588869.
- ↑ Kaya M, Beştaş R, Cetin S (2011). "Clinical presentation and management of Fasciola hepatica infection: single-center experience". World J Gastroenterol. 17 (44): 4899–904. doi:10.3748/wjg.v17.i44.4899. PMC 3235633. PMID 22171131.
- ↑ Gower CM, Gouvras AN, Lamberton PH, Deol A, Shrivastava J, Mutombo PN; et al. (2013). "Population genetic structure of Schistosoma mansoni and Schistosoma haematobium from across six sub-Saharan African countries: implications for epidemiology, evolution and control". Acta Trop. 128 (2): 261–74. doi:10.1016/j.actatropica.2012.09.014. PMID 23041540.
- ↑ Jauréguiberry S, Ansart S, Perez L, Danis M, Bricaire F, Caumes E (2007). "Acute neuroschistosomiasis: two cases associated with cerebral vasculitis". Am J Trop Med Hyg. 76 (5): 964–6. PMID 17488923.
- ↑ Rocha MO, Rocha RL, Pedroso ER, Greco DB, Ferreira CS, Lambertucci JR; et al. (1995). "Pulmonary manifestations in the initial phase of schistosomiasis mansoni". Rev Inst Med Trop Sao Paulo. 37 (4): 311–8. PMID 8599059.
- ↑ Lucey DR, Maguire JH (1993). "Schistosomiasis". Infect Dis Clin North Am. 7 (3): 635–53. PMID 8254164.
- ↑ Stothard JR, Sousa-Figueiredo JC, Betson M, Bustinduy A, Reinhard-Rupp J (2013). "Schistosomiasis in African infants and preschool children: let them now be treated!". Trends Parasitol. 29 (4): 197–205. doi:10.1016/j.pt.2013.02.001. PMC 3878762. PMID 23465781.
- ↑ Gabbi C, Bertolotti M, Iori R, Rivasi F, Stanzani C, Maurantonio M; et al. (2006). "Acute abdomen associated with schistosomiasis of the appendix". Dig Dis Sci. 51 (1): 215–7. doi:10.1007/s10620-006-3111-5. PMID 16416239.
- ↑ Mu A, Fernandes I, Phillips D (2016). "A 57-Year-Old Woman With a Cecal Mass". Clin Infect Dis. 63 (5): 703–5. doi:10.1093/cid/ciw413. PMID 27521443.
- ↑ Homeida M, Abdel-Gadir AF, Cheever AW, Bennett JL, Arbab BM, Ibrahium SZ; et al. (1988). "Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study". Am J Trop Med Hyg. 38 (1): 86–91. PMID 3124648.
- ↑ Dessein AJ, Hillaire D, Elwali NE, Marquet S, Mohamed-Ali Q, Mirghani A; et al. (1999). "Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene". Am J Hum Genet. 65 (3): 709–21. doi:10.1086/302526. PMC 1377977. PMID 10441577.
- ↑ Sarwat AK, Tag el Din MA, Bassiouni M, Ashmawi SS (1986). "Schistosomiasis of the lung". J Egypt Soc Parasitol. 16 (1): 359–66. PMID 3722898.
- ↑ Mahmoud AA (1982). "The ecology of eosinophils in schistosomiasis". J Infect Dis. 145 (5): 613–22. PMID 7042854.
- ↑ Cioli D, Pica-Mattoccia L, Basso A, Guidi A (2014). "Schistosomiasis control: praziquantel forever?". Mol Biochem Parasitol. 195 (1): 23–9. doi:10.1016/j.molbiopara.2014.06.002. PMID 24955523.
- ↑ Carroll SM, Karthigasu KT, Grove DI (1981). "Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay". Trans R Soc Trop Med Hyg. 75 (5): 706–9. PMID 7036430.
- ↑ Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H (2002). "Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart". J Infect Chemother. 8 (1): 94–8. doi:10.1007/s101560200013. PMID 11957127.
- ↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
- ↑ Valenzuela O, Morán P, Gómez A, Cordova K, Corrales N, Cardoza J; et al. (2007). "Epidemiology of amoebic liver abscess in Mexico: the case of Sonora". Ann Trop Med Parasitol. 101 (6): 533–8. doi:10.1179/136485907X193851. PMID 17716437.
- ↑ van Hal SJ, Stark DJ, Fotedar R, Marriott D, Ellis JT, Harkness JL (2007). "Amoebiasis: current status in Australia". Med J Aust. 186 (8): 412–6. PMID 17437396.
- ↑ Ximénez C, Morán P, Rojas L, Valadez A, Gómez A (2009). "Reassessment of the epidemiology of amebiasis: state of the art". Infect Genet Evol. 9 (6): 1023–32. doi:10.1016/j.meegid.2009.06.008. PMID 19540361.
- ↑ Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G (1998). "Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children". Lancet. 352 (9134): 1103–8. PMID 9798586.
- ↑ Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G (1998). "Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children". Lancet. 352 (9134): 1103–8. PMID 9798586.
- ↑ Rossignol JF, Maisonneuve H (1984). "Benzimidazoles in the treatment of trichuriasis: a review". Ann Trop Med Parasitol. 78 (2): 135–44. PMID 6378109.
- ↑ Steinmann P, Utzinger J, Du ZW, Jiang JY, Chen JX, Hattendorf J; et al. (2011). "Efficacy of single-dose and triple-dose albendazole and mebendazole against soil-transmitted helminths and Taenia spp.: a randomized controlled trial". PLoS One. 6 (9): e25003. doi:10.1371/journal.pone.0025003. PMC 3181256. PMID 21980373.
- ↑ Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N; et al. (2010). "Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories". Clin Microbiol Infect. 16 (3): 267–73. doi:10.1111/j.1469-0691.2009.02782.x. PMID 19456836.
- ↑ 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.
- ↑ Steinmann P, Cringoli G, Bruschi F, Matthys B, Lohourignon LK, Castagna B; et al. (2012). "FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods". Parasitol Res. 111 (2): 749–54. doi:10.1007/s00436-012-2895-9. PMID 22461006.
- ↑ Ohnishi K, Sakamoto N, Kobayashi K, Iwabuchi S, Nakamura-Uchiyama F (2013). "Therapeutic effect of praziquantel against Taeniasis asiatica". Int J Infect Dis. 17 (8): e656–7. doi:10.1016/j.ijid.2013.02.028. PMID 23618773.
- ↑ Pawłowski ZS (1990). "Efficacy of low doses of praziquantel in taeniasis". Acta Trop. 48 (2): 83–8. PMID 1980572.