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Treatments for Gastrointestinal bleeding
- Treatment list for Gastrointestinal bleeding
- Medical news summaries about treatments for Gastrointestinal bleeding
- Discussion of treatments for Gastrointestinal bleeding
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- Introduction: Gastrointestinal bleeding
Treatment list for Gastrointestinal bleeding:
The list of treatments mentioned in various sources for Gastrointestinal bleeding includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Treatments for gastrointestinal bleeding emergencies:
- See also treatment of anemia - because anemia can result from gastrointestinal bleeding and its blood loss.
- See also treatment of dehydration
Treatments of Gastrointestinal bleeding: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Gastrointestinal bleeding.
Hemorrhoids:
Treatment
(In a Page: Signs and Symptoms)
- Treatment is initially conservative: High-fiber diet, stool softeners, appropriate anal hygiene, sitz baths, and topical steroids
- Surgical options include rubber band ligation of internal hemorrhoids or surgical resection for large refractory hemorrhoids
- Acute thrombosis of a hemorrhoid may require incision and drainage
Rectal Pain:
Treatment
(In a Page: Signs and Symptoms)
- Acute anal fissure: 90% heal within 3–4 weeks with conservative management (increased fiber and water intake, stool softeners, Sitz bath, topical corticosteroids)
- Chronic anal fissure: Only 40% heal with conservative treatment; sphincterotomy (<5% risk of significant incontinence) is the treatment of choice
- Perianal abscess: Requires incision and drainage followed by packing and Sitz baths until healed
- Levator ani syndrome: Decrease anal canal pressure by digital massage (3–4/week), Sitz baths, muscle relaxants
- Proctalgia fugax: Self-limited, infrequent brief attacks; primary treatment is reassurance; treat any underlying psychological disorders
- Coccyodynia: Warm Sitz baths, analgesics, and corticosteroid injections; coccygectomy may be indicated in rare cases
- Thrombosed hemorrhoid: Incision and drainage or surgical excision
GI Bleeding - Melena & Hematochezia:
Treatment
(In a Page: Signs and Symptoms)
- Ensure adequate airway, breathing, and circulation
-
Stabilize and resuscitate patients as necessary
–Insert two large-bore IV lines
–Administer IV fluids
–Type and cross match two units of packed RBCs
–Administer blood transfusion if necessary
–Correct coagulopathies if present (e.g., fresh frozen plasma, vitamin K, platelets) - Several options are available to treat persistent bleeding: Endoscopic sclerotherapy, electrocautery, or laser coagulation; angiographic embolization; or resection
- Diverticular hemorrhage: Resection may be indicated
- Angiodysplasia: Endoscopy or resection
- Colorectal cancer and/or polyps: Excision or resection
- Infectious colitis: Appropriate antibiotic regimens
- Inflammatory bowel disease: Steroids and aminosalicylates; resection for severe disease
- Aortoenteric fistula requires repair of bowel, graft excision, and extra-anatomic bypass graft
GI Bleeding - Hematemesis:
Treatment
(In a Page: Signs and Symptoms)
- Ensure adequate airway, breathing, and circulation
-
Stabilize and resuscitate patients as necessary
–Insert two large-bore IV lines
–Administer IV fluids (Ringer's lactate or normal saline)
–Type and cross match two units of packed RBCs
–Correct coagulopathies if present (e.g., fresh frozen plasma, vitamin K, platelets)
–Consider blood transfusion -
Identify and treat the source of bleeding
–IV octreotide (vasoconstrictor) infusion
–Vasopressin for significant variceal bleeding (contraindicated in CAD or CVA patients)
–Endoscopy with injection of vasoconstrictors (e.g., epinephrine), sclerosing agents, or electrocautery
–Angiography with visualization of bleeding vessel and subsequent embolization
–Surgical control of bleeding if all else fails - H2 blockers or proton pump inhibitors may be started for suspected peptic ulcer disease or gastritis
Hematochezia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Treatment is directed at the underlying cause
- Correct hemodynamic instability with volume expansion, pressure support, and blood transfusion
- Milk protein allergy: Protein hydrolysate formulas
- NEC: Antibiotics and supportive therapy, surgery for perforation
- IBD: Anti-inflammatory (e.g. steroids, 6MP, 5ASA)
- Hemangiomas: Corticosteroids or alpha-interferon
- Infectious colitis: Antibiotics for Shigella, Campylobacter,
- difficile, and amebiasis; treat Salmonella only in very young or febrile infants
- Endoscopic therapy: Polypectomy for juvenile polyp, elastic band ligation, sclerotherapy, and/or electrotherapy for vascular anomalies.
- Surgery: Indicated for failure of radiographic reduction of intussuception, volvulus, or other ischemic injuries; Meckel diverticulum, and vascular anomalies
- Stool softeners for anorectal fissures
Hematochezia:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient has severe hematochezia, check his vital signs. If you detect signs of shock, such as hypotension and tachycardia, place the patient in a supine position and elevate his feet 20 to 30 degrees. Prepare to administer oxygen, and start a large-bore I
V. line for emergency fluid replacement. Next, obtain a blood sample for typing and crossmatching, hemoglobin level, and hematocrit. Insert a nasogastric tube. Iced lavage may be indicated to control bleeding. Endoscopy may be necessary to detect the source of bleeding.
Melena:
Emergency Interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient is experiencing severe melena, quickly take his orthostatic vital signs to detect hypovolemic shock. A decline of 10 mm Hg or more in systolic pressure or an increase of 10 beats/minute or more in the pulse rate indicates volume depletion. Quickly examine the patient for other signs of shock, such as tachycardia, tachypnea, and cool, clammy skin. Insert a large-bore I.V. line to administer replacement fluids and allow for blood transfusion. Obtain hematocrit, prothrombin time, International Normalized Ratio, and partial thromboplastin time. Place the patient flat with his head turned to the side and his feet elevated. Administer supplemental oxygen as needed.
Hemorrhoids:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment depends on the type and severity of the hemorrhoid and on the patient’s overall condition. Generally, treatment includes measures to ease pain, combat swelling and congestion, and regulate bowel habits. The patient can relieve constipation by increasing the amount of raw vegetables, fruit, and whole grain cereal in the diet or by using stool softeners. Venous congestion can be prevented by avoiding prolonged sitting; local swelling and pain can be decreased with local anesthetic agents (lotions, creams, or suppositories), astringents, or cold compresses, followed by warm sitz baths or thermal packs. Rarely, the patient with chronic, profuse bleeding may require a blood transfusion. Other nonsurgical treatments are injection of a sclerosing solution to produce scar tissue that decreases prolapse, manual reduction, and hemorrhoid ligation or laser ablation.
Hemorrhoidectomy, the most effective treatment, is necessary for patients with severe bleeding, intolerable pain and pruritus, and large prolapse. This procedure is contraindicated in patients with blood dyscrasias (acute leukemia, aplastic anemia, or hemophilia) or GI carcinoma and during the first trimester of pregnancy.
Postmenopausal bleeding:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Emergency treatment to control massive hemorrhage is rarely necessary, except in advanced cancer. Treatment may include D & C to relieve bleeding. Other therapy varies according to the underlying cause. Estrogen creams and suppositories are usually effective in correcting estrogen deficiency because they’re rapidly absorbed. Hysterectomy is indicated for repeated episodes of postmenopausal bleeding from the endometrial cavity. Such bleeding may indicate endometrial cancer.
Melena:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is experiencing severe melena, quickly take orthostatic vital signs to detect hypovolemic shock. A decline of 10 mm Hg or more in systolic pressure or an increase of 10 beats/minute or more in pulse rate indicates volume depletion. Quickly examine patient for other signs of shock, such as tachycardia, tachypnea, and cool, clammy skin. Insert a large-bore I.V. line to administer replacement fluids and allow blood transfusion. Obtain hematocrit, prothrombin time, international normalized ratio, and partial thromboplastin time. Place the patient flat with his head turned to the side and his feet elevated. Administer supplemental oxygen as needed.
Rectal pain:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Teach the patient how to apply hot, moist compresses. Teach him how to give himself a sitz bath; this will ease his discomfort by helping to relieve the sphincter spasm associated with most anorectal disorders. Stress the importance of following a proper diet and drinking plenty of fluids to maintain soft stools and thus avoid aggravating pain during defecation.
Hematochezia [Rectal bleeding]:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient has severe hematochezia, check his vital signs. If you detect signs of shock, such as hypotension and tachycardia, place the patient in a supine position and elevate his feet 20 to 30 degrees. Prepare to administer oxygen, and start a large-bore I.V. line for emergency fluid replacement. Next, obtain a blood sample for typing and crossmatching, hemoglobin level, and hematocrit. Insert a nasogastric tube. Iced lavage may be indicated to control bleeding. Endoscopy may be necessary to detect the source of the bleeding.
Vaginal bleeding, postmenopausal:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Reassure the patient that most cases of postmenopausal vaginal bleeding are benign and not cancer related.
Hemorrhoids:
Treatment
(Handbook of Diseases)
Treatment depends on the type and severity of the hemorrhoids.
Nonsurgical treatments
Nonsurgical treatments include measures to control pain, combat swelling and congestion, and regulate bowel habits. Patients can relieve constipation by consuming a high-fiber diet and increasing fluid intake by drinking eight to ten 8-oz glasses of water per day or by using bulking agents such as psyllium.
Venous congestion can be prevented by avoiding prolonged sitting on the toilet; local swelling and pain can be decreased with local anesthetic agents (lotions, creams, or suppositories) or astringents. Hydrocortisone suppositories may be used for edematous, prolapsed hemorrhoids in combination with warm sitz baths.
Hemorrhoids may be treated with injection sclerotherapy and rubber band ligation. Infrared photocoagulation bipolar diathermy may be used to affix the mucosa to the underlying muscle.
Clinical tip There’s no evidence that topical cleaners or lotions (pads, foams, ointments) cause symptomatic hemorrhoids to shrink; they only provide relief by soothing the area.
Hemorrhoidectomy
Hemorrhoidectomy is performed for patients with severe bleeding and those with thrombosed hemorrhoids. This procedure is contraindicated in patients with blood dyscrasias (acute leukemia, aplastic anemia, or hemophilia) or gastric cancer and during the first trimester of pregnancy.
Hematochezia:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Place the patient on bed rest and check his vital signs frequently, watching for signs of shock, such as hypotension, tachycardia, weak pulse, and tachypnea. Monitor the patient’s intake and output hourly. Remember to provide emotional support because hematochezia may frighten the patient.
Prepare the patient for blood tests and
GI procedures, such as endoscopy and GI X-rays. Visually examine the patient’s stools and test them for occult blood. If necessary, send a stool sample to the laboratory to check for parasites.
Patient teaching
Provide information to the patient on signs and symptoms to report immediately. Teach the patient about ostomy self-care and consult the ostomy nurse or a home health care nurse to provide support to the patient upon discharge from the facility, as appropriate. Discuss proper bowel elimination habits. Explain dietary recommendations and restrictions.
Melena:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Monitor vital signs, and look closely for signs of hypovolemic shock. For general comfort, encourage bed rest, and keep the patient’s perianal area clean and dry to prevent skin irritation and breakdown. A nasogastric tube may be necessary to assist with drainage of gastric contents and decompression. Prepare him for diagnostic tests, including blood studies, gastroscopy or other endoscopic studies, barium swallow, and upper GI series. Prepare the patient for blood transfusions as indicated by his hematocrit.
ALERT: If the patient requires large volumes of blood, be alert for changes in calcium levels because calcium binds to citrate in the stored blood, thereby decreasing the body’s free calcium levels. Monitor serum calcium levels, and anticipate replacement if levels are low. Also be alert for coagulation problems, because transfusions of large amounts of blood can cause coagulopathy.
Patient teaching
Explain the changes in bowel elimination that are important for the patient to recognize and report. Stress the importance of undergoing colorectal cancer screening. Explain to the patient the need to avoid aspirin, other NSAIDS, anticoagulants, and alcohol. Instruct the patient on a diet rich in natural fiber, which may decrease the incidence of constipation; provide consultation to a dietitian if necessary.
Hematochezia:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient has severe hematochezia, check his vital signs. If you detect signs of shock, such as hypotension and tachycardia, place him in a supine position and elevate his feet 20 to 30 degrees. Prepare to administer oxygen, and start a large-bore I.V. line for emergency fluid replacement. Next, obtain a blood sample for typing and crossmatching, hemoglobin level, and hematocrit. Insert a nasogastric tube. Iced lavage may be indicated to control bleeding. Endoscopy may be necessary to detect the source of the bleeding.
Melena:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient is experiencing severe melena, quickly take orthostatic vital signs to detect hypovolemic shock. A decline of 10 mm Hg or more in systolic pressure or an increase of 10 beats/minute or more in pulse rate indicates volume depletion. Quickly examine the patient for other signs of shock, such as tachycardia, tachypnea, and cool, clammy skin. Insert a large-bore I.V. line to administer replacement fluids and allow blood transfusion. Obtain a hematocrit, prothrombin time, International Normalized Ratio, and partial thromboplastin time. Place the patient flat with his head turned to the side and his feet elevated. Administer supplemental oxygen as needed.
Rectal pain:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient how to apply hot, moist compresses. Also teach him how to give himself a sitz bath; this will ease his discomfort by helping to relieve the sphincter spasm associated with most anorectal disorders. Stress the importance of following a proper diet and drinking plenty of fluids to maintain soft stools and thus avoid aggravating pain during defecation.
Vaginal bleeding, postmenopausal:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Reassure the patient that most postmenopausal vaginal bleeding is benign and not cancer related.
Melena:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs, and look closely for signs of hypovolemic shock.
▪ Encourage bed rest, if the patient is unstable.
▪ Provide good skin care and monitor skin integrity.
▪ Insert a nasogastric tube, if indicated, to assist with drainage of gastric contents and decompression.
▪ Prepare the patient for diagnostic tests, including blood studies, gastroscopy or other endoscopic studies, barium swallow, and upper GI series, and for blood transfusions as indicated by his hematocrit.
Patient teaching
▪ Explain the underlying cause of melena and its treatment.
▪ Explain bowel elimination changes that the patient needs to report.
▪ Stress the importance of colorectal cancer screening.
▪ Reinforce the need to avoid aspirin, other nonsteroidal anti-inflammatory drugs, and alcohol.
Rectal pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply analgesic ointment or suppositories.
▪ Administer a stool softener if needed.
▪ If the rectal pain results from prolapsed hemorrhoids, apply cold compresses to help shrink protruding hemorrhoids, prevent thrombosis, and reduce pain.
▪ If the patient's condition permits, place him in Trendelenburg's position with his buttocks elevated to further relieve pain.
▪ Prepare the patient for an anoscopic examination and proctosigmoidoscopy to determine the cause of the rectal pain, if indicated.
▪ Because the patient may feel embarrassed, provide emotional support and as much privacy as possible.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Instruct the patient on measures to ease discomfort.
▪ Discuss proper diet and fluid intake.
▪ Explain the use of stool softeners.
Hematochezia [Rectal bleeding]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Place the patient on bed rest.
▪ Check vital signs frequently, watching for signs of shock, such as hypotension, tachycardia, a weak pulse, and tachypnea.
▪ Monitor the patient's intake and output hourly.
▪ Monitor hemoglobin level and hematocrit.
▪ Administer blood products as ordered.
▪ Provide emotional support because hematochezia may frighten the patient.
▪ Prepare the patient for blood tests and GI procedures, such as endoscopy and GI X-rays.
▪ Visually examine the patient's stools and test them for occult blood.
▪ If necessary, send a stool specimen to the laboratory to check for parasites.
Patient teaching
▪ Explain signs and symptoms that require immediate medical attention.
▪ Teach the patient about ostomy self-care, as appropriate.
▪ Discuss proper bowel elimination habits.
▪ Explain dietary recommendations and restrictions.
▪ Teach the patient about prescribed medications.
Vaginal bleeding, postmenopausal:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, such as ultrasonography, endometrial biopsy, colposcopy, dilatation and curettage, and vaginal and cervical cultures.
▪ Discontinue estrogen until a diagnosis is made.
Patient teaching
▪ Reassure the patient that postmenopausal vaginal bleeding may be benign, but careful assessment is needed.
▪ Teach the patient about the underlying cause and its treatment.
Medical news summaries about treatments for Gastrointestinal bleeding:
The following medical news items are relevant to treatment of Gastrointestinal bleeding:
- New website offers information that should raise competitiveness of drugs
- Nobel Prize for Medicine to discoverers of bacteria causing ulcers
- Risk of bleeding increases when COX-2 inhibitor use is combined with warfarin
- Suspension of Aleve comes as a surprise
- Vioxx tended not to be used by targeted group
Discussion of treatments for Gastrointestinal bleeding:
The use of endoscopy has grown and now allows doctors not only to see bleeding sites but to directly apply therapy as well. A variety of endoscopic therapies are useful to the patient for treating GI tract bleeding.Active bleeding from the upper GI tract can often be controlled by injecting chemicals directly into a bleeding site with a needle introduced through the endoscope. A physician can also cauterize, or heat treat, a bleeding site and surrounding tissue with a heater probe or electrocoagulation device passed through the endoscope. Laser therapy, although effective, is no longer used regularly by many physicians because it is expensive and cumbersome.
Once bleeding is controlled, medicines are often prescribed to prevent recurrence of bleeding. Medical treatment of ulcers to ensure healing and maintenance therapy to prevent ulcer recurrence can also lessen the chance of recurrent bleeding. Studies are now under way to see if elimination of Helicobacter pylori affects the recurrence of ulcer bleeding.
Removal of polyps with an endoscope can control bleeding from colon polyps. Removal of hemorrhoids by banding or various heat or electrical devices is effective in patients who suffer hemorrhoidal bleeding on a recurrent basis. Endoscopic injection or cautery can be used to treat bleeding sites throughout the lower intestinal tract.
Endoscopic techniques do not always control bleeding. Sometimes angiography may be used. However, surgery is often needed to control active, severe, or recurrent bleeding when endoscopy is not successful. (Source: excerpt from Bleeding in the Digestive Tract: NIDDK)
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