Sandbox spinalcord: Difference between revisions
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| <figure-inline><figure-inline>[[File:Siren.gif|link=Lower gastrointestinal bleeding resident survival guide|41x41px]]</figure-inline></figure-inline>|| <br> || <br> | | <figure-inline><figure-inline><figure-inline>[[File:Siren.gif|link=Lower gastrointestinal bleeding resident survival guide|41x41px]]</figure-inline></figure-inline></figure-inline>|| <br> || <br> | ||
| [[Lower gastrointestinal bleeding resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | [[Lower gastrointestinal bleeding resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
|}{{Infobox_Disease | | |}{{Infobox_Disease | | ||
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=== Focal nodular hyperplasia === | === Focal nodular hyperplasia === | ||
* Due to their benign nature of focal nodular hyperplasia, there is | * 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. | * 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. | ||
Revision as of 20:01, 5 February 2018
<figure-inline><figure-inline><figure-inline> </figure-inline></figure-inline></figure-inline> |
Resident Survival Guide |
| Sandbox spinalcord | |
| ICD-10 | K92.2 |
|---|---|
| ICD-9 | 578.9 |
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.