摘要:

Progress has been made in the evaluation and treatment of gastrointestinal bleeding. HemeSelect (SmithKline Diagnostics, San Jose, CA) seems to give the best specificity and sensitivity for occult bleeding. Iron-deficiency anemia requires an evaluation for colon carcinoma. Endoscopic ultrasound may be helpful in locating the source of obscure gastrointestinal bleeding. A conservative approach to gastrointestinal bleeding in children and infants is often successful. Nonsteroidal anti-inflammatory drugs may cause many of the same small intestine and colon problems as aspirin. Free radical scavengers, sulfhydryl-containing agents, and metronidazole may diminish gut complications arising from nonsteroidal anti-inflammatory drugs or aspirin. Variceal ligation may prove to be safer and more effective than sclerotherapy. The combination of nitroglycerin and vasopressin seems to be more effective for portal hypertensive bleeding than either alone. Somatostatin may be as effective but is more expensive. Angiography and embolization therapy for bleeding remain important parts of our armamentarium.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Major articles in the past year that have contributed to our understanding of critical care issues involving disorders of the small bowel include papers on drug side effects, new modalities for treating diarrhea, postoperative ileus, ischemia reperfusion injury to the small bowel, chronic intestinal ischemia, and small bowel obstruction. New insights on the diagnosis and management of these conditions are described.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Colon-related disorders are frequently encountered in the ICU. Despite advances in diagnostic imaging, plain abdominal films continue to be a valuable modality. Recently, diagnostic laparoscopy has been advocated to be a promising modality in critically ill patients.Clostridium difficile-associateddisease and acute colonic pseudo-obstruction are conditions fraught with high rates of relapse that pose major diagnostic and therapeutic dilemmas. Recent advances include new methods forC. difficilemolecular typing and serogroup-specific antigen assays, which would be advantageous primarily in epidemiologic tracing.Saccharomyces boulardiiappears to be a promising agent in recurrentC. difficile-associateddiseases. New techniques for laparoscopically guided cecostomy and pulsed irrigation-enhanced evacuation may play an important role in the management of acute colonic pseudo-obstruction and fecal impaction, respectively. Unusual colonic conditions, including colonic varices, portal colopathy, and Dieulafoy's lesion of the colon, may account for rare cases of lower gastrointestinal bleeding.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Critically ill patients usually manifest evidence of hepatobiliary disease. The liver is frequently affected in patients with multiple organ dysfunction syndrome. Liver dysfunction may occur without concomitant abnormalities of liver enzymes. Multiple drugs can affect the liver, and new syndromes related to hepatic drug toxicity have been described. Patients receiving total parenteral nutrition are at risk for developing hepatobiliary disorders. The mechanisms underlying the hepatic toxicity of total parenteral nutrition continue to be explored. Acute acalculous cholecystitis is a serious complication of critically ill patients that may be difficult to recognize. New insights on diagnosis and management of this condition are described.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Patients with severe pancreatitis have systemic complications and a pathologic process that usually includes pancreatic and peripancreatic necrosis. Survival of the patient with severe acute pancreatitis often depends on appropriate management during the first few days after the onset of symptoms. In addition, unrecognized systemic complications may contribute to the increased mortality found in patients with severe pancreatitis. It is, therefore, important to determine as early as possible which patients have severe disease so that proper therapy may be instituted. This review concentrates on current issues associated with necrotizing pancreatitis as well as the evolving modalities of endoscopic sphincterotomy and laparoscopic cholecystectomy in the management of biliary pancreatitis. The prognosis of patients surviving severe pancreatitis has also received more attention in the literature.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID