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By Terren Trott
Brit Long, Alex Koyfman
BACKGROUND: Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider. OBJECTIVE OF THE REVIEW: Provide an evidence-based update for the resuscitation of decompensating cirrhotic patients and an overview of cirrhosis complications...
April 2018: American Journal of Emergency Medicine
Lauren R Klein, Joel Money, Kaveesh Maharaj, Aaron Robinson, Tarissa Lai, Brian E Driver
BACKGROUND: Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. METHODS: This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization...
November 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
L Daniels, Ç Ünlü, N de Korte, S van Dieren, H B Stockmann, B C Vrouenraets, E C Consten, J A van der Hoeven, Q A Eijsbouts, I F Faneyte, W A Bemelman, M G Dijkgraaf, M A Boermeester
BACKGROUND: Antibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis. METHODS: Patients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy...
January 2017: British Journal of Surgery
Michael Gottlieb, Benton Hunter
No abstract text is available yet for this article.
March 2017: Annals of Emergency Medicine
Phillip S Ge, Bruce A Runyon
No abstract text is available yet for this article.
August 13, 2014: JAMA: the Journal of the American Medical Association
Abhijai Singh, Mahesh Shrestha, Curuchi Anand
No abstract text is available yet for this article.
May 2016: American Journal of Emergency Medicine
Vipul Jairath, Brennan C Kahan, Alasdair Gray, Caroline J Doré, Ana Mora, Martin W James, Adrian J Stanley, Simon M Everett, Adam A Bailey, Helen Dallal, John Greenaway, Ivan Le Jeune, Melanie Darwent, Nicholas Church, Ian Reckless, Renate Hodge, Claire Dyer, Sarah Meredith, Charlotte Llewelyn, Kelvin R Palmer, Richard F Logan, Simon P Travis, Timothy S Walsh, Michael F Murphy
BACKGROUND: Transfusion thresholds for acute upper gastrointestinal bleeding are controversial. So far, only three small, underpowered studies and one single-centre trial have been done. Findings from the single-centre trial showed reduced mortality with restrictive red blood cell (RBC) transfusion. We aimed to assess whether a multicentre, cluster randomised trial is a feasible method to substantiate or refute this finding. METHODS: In this pragmatic, open-label, cluster randomised feasibility trial, done in six university hospitals in the UK, we enrolled all patients aged 18 years or older with new presentations of acute upper gastrointestinal bleeding, irrespective of comorbidity, except for exsanguinating haemorrhage...
July 11, 2015: Lancet
Jennifer A Horst, Indi Trehan, Brad W Warner, Brian G Cohn
No abstract text is available yet for this article.
August 2015: Annals of Emergency Medicine
H S de Vries, D Boerma, R Timmer, B van Ramshorst, L A Dieleman, H L van Westreenen
BACKGROUND: It is generally accepted that patients following an episode of diverticulitis should have additional colonoscopy screening to rule out a colorectal malignancy. We aimed to investigate the rate of CRC found by colonoscopy after an attack of uncomplicated diverticulitis. METHODS: MEDLINE, Embase, and Cochrane databases were searched systematically for clinical trials or observational studies on colonic evaluation by colonoscopy after the initial diagnosis of acute uncomplicated diverticulitis, followed by hand-searching of reference lists...
July 2014: Surgical Endoscopy
Arden M Morris, Scott E Regenbogen, Karin M Hardiman, Samantha Hendren
IMPORTANCE: Diverticulitis is a common disease. Recent changes in understanding its natural history have substantially modified treatment paradigms. OBJECTIVE: To review the etiology and natural history of diverticulitis and recent changes in treatment guidelines. EVIDENCE REVIEW: We searched the MEDLINE and Cochrane databases for English-language articles pertaining to diagnosis and management of diverticulitis published between January 1, 2000, and March 31, 2013...
January 15, 2014: JAMA: the Journal of the American Medical Association
Michael T Cudnik, Subrahmanyam Darbha, Janice Jones, Julian Macedo, Sherrill W Stockton, Brian C Hiestand
OBJECTIVES: Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED...
November 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jennifer C Cabot, Kaushal Shah
No abstract text is available yet for this article.
June 2014: Annals of Emergency Medicine
Càndid Villanueva, Alan Colomo, Alba Bosch, Mar Concepción, Virginia Hernandez-Gea, Carles Aracil, Isabel Graupera, María Poca, Cristina Alvarez-Urturi, Jordi Gordillo, Carlos Guarner-Argente, Miquel Santaló, Eduardo Muñiz, Carlos Guarner
BACKGROUND: The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy. METHODS: We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter)...
January 3, 2013: New England Journal of Medicine
Ihsan Ekin Demir, Güralp O Ceyhan, Helmut Friess
BACKGROUND/AIMS: Measurement of serum lactate remains the most frequently applied laboratory investigation to diagnose acute mesenteric (intestinal) ischemia. The present review aims at critically questioning the widespread measurement of serum lactate to diagnose acute mesenteric ischemia in clinical practice and at drawing attention to more novel markers of intestinal ischemia. METHODS: An electronic search of multiple databases was performed with the key words 'lactate', 'marker', 'mesenteric', 'intestinal' and 'ischemia' to detect all relevant studies...
2012: Digestive Surgery
Juan Carlos García-Pagán, Enric Reverter, Juan G Abraldes, Jaime Bosch
Bleeding from gastroesophageal varices is a frequent complication of cirrhosis. Mortality from a variceal bleeding episode has decreased in the last 2 decades from 40% to 15 to 20% due to the implementation of effective treatments and improvement in the general medical care. Initial treatment should include adequate fluid resuscitation and transfusion to maintain hemoglobin around 7 to 8 g/dL, and prophylactic antibiotics (norfloxacin or ceftriaxone). It is currently recommended that a vasoactive drug be started as soon as variceal bleeding is suspected...
February 2012: Seminars in Respiratory and Critical Care Medicine
F Douglas Srygley, Charles J Gerardo, Tony Tran, Deborah A Fisher
CONTEXT: Emergency physicians must determine both the location and the severity of acute gastrointestinal bleeding (GIB) to optimize the diagnostic and therapeutic approaches. OBJECTIVES: To identify the historical features, symptoms, signs, bedside maneuvers, and basic laboratory test results that distinguish acute upper GIB (UGIB) from acute lower GIB (LGIB) and to risk stratify those patients with a UGIB least likely to have severe bleeding that necessitates an urgent intervention...
March 14, 2012: JAMA: the Journal of the American Medical Association
A Chabok, L Påhlman, F Hjern, S Haapaniemi, K Smedh
BACKGROUND: The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. The aim was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis, with the endpoint of recovery without complications after 12 months of follow-up. METHODS: This multicentre randomized trial involving ten surgical departments in Sweden and one in Iceland recruited 623 patients with computed tomography-verified acute uncomplicated left-sided diverticulitis...
April 2012: British Journal of Surgery
Edward S Huang, Sundip Karsan, Fasiha Kanwal, Inder Singh, Marc Makhani, Brennan M Spiegel
BACKGROUND: Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management. OBJECTIVE: We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding. DESIGN: Propensity-matched retrospective analysis. SETTING: University-based Veterans Affairs medical center...
November 2011: Gastrointestinal Endoscopy
N C Chavez-Tapia, T Barrientos-Gutierrez, F Tellez-Avila, K Soares-Weiser, N Mendez-Sanchez, C Gluud, M Uribe
BACKGROUND: Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. AIM: To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010...
September 2011: Alimentary Pharmacology & Therapeutics
Nicholas Palamidessi, Richard Sinert, Louise Falzon, Shahriar Zehtabchi
OBJECTIVES: The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? METHODS: MEDLINE, EMBASE, the Cochrane Library, and other databases were searched...
February 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2015-08-27 19:35:33
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