Etiology Of Bleeding Research Articles

Etiology and Diagnosis of Heavy Menstrual Bleeding among Adolescent and Adult Patients: A Systematic Review and Meta-Analysis of the Literature

BackgroundHeavy menstrual bleeding (HMB) is excessive menstrual blood loss that interferes with an individual’s quality of life. Many individuals with HMB are inadequately managed by healthcare providers. This systematic review aims to provide a comprehensive summary of the etiologies and diagnosis of HMB while calculating the prevalence of underlying causes among premenopausal patients and quantifying the test accuracy of diagnostic strategies. MethodsMEDLINE, EMBASE, the Cochrane Library, and Web of Science were searched since inception to include studies investigating the prevalence of underlying etiology and diagnostic accuracy of investigations for HMB. The primary outcome was the prevalence of the causes of HMB, secondary outcome included the prevalence of etiology by age. Meta-analyses were conducted via random effects model. Results53 studies were included. Forty-five studies included data on the prevalence of underlying HMB etiology, totaling 41541patients. The overall prevalence of bleeding disorders was 30% [95% CI 14–46], von Willebrand disease (VWD) of 8% [95% CI 7–10], platelet function defect (PFD) of 9% [95% CI 7–12], abnormal thyroid of 3% [95% CI 0–6], and polycystic ovarian syndrome (PCOS) of 8% [95% CI 4–12]. Subgroup analysis showed bleeding disorders were prevalent in 16% [95% CI -8–41] of adults with HMB, but 39% [95% CI 18–60] of adolescents with HMB. ConclusionsMany diagnoses were associated with bleeding disorders and, therefore, warrant investigation when assessing a patient with HMB of unknown etiology. The causes are likely age-dependent and should be considered when diagnosing HMB.

Case Report of Rectosigmoid Vascular Malformation

Abstract Introduction/Objective Gastrointestinal (GI) vascular malformations and hemangiomas, although infrequently encountered, can present with similar clinical symptoms as other more common causes of chronic hematochezia, such as hemorrhoids or inflammatory bowel disease (IBD, ex. Crohn’s disease, ulcerative colitis). Whereas hemangiomas are benign vascular tumors that grow quickly and often involute, vascular malformations consist of abnormal vasculature that grow in size as the individual ages without regression. Gastrointestinal vascular malformations can result in pain secondary to applied pressure on nearby tissues/organs and induce a chronic anemic state secondary to ongoing hematochezia. As surgery or sclerotherapy can often treat the condition, proper diagnosis is critical as it can impact treatment and quality of life. Among GI vascular malformations, rectosigmoid vascular malformations are uncommon, making up 5% of lower limb vascular malformations examined in recent published literature. In this case report, we highlight a case of rectosigmoid vascular malformation. Methods/Case Report A 41-year-old female, initially treated for inflammatory bowel disease (IBD), presents with multiple bloody bowel movements a day accompanied by nausea secondary to chronic proctosigmoiditis refractory to medications traditionally used in IBD: mesalamine derivatives, systemic corticosteroid, and biologics. While colonoscopy demonstrated some features suggestive of ulcerative colitis, CT and MR enterography showed severe rectal wall thickening with phleboliths, which was unchanged over many years, suggestive of a vascular malformation such as a hemangioma. Following rectosigmoid colon resection, a diagnosis of a 9 cm rectosigmoid vascular malformation was made, showing extensive bowel wall involvement by the malformed vasculature. On follow-up, the patient is doing well, and her symptoms have completely resolved. Results (if a Case Study enter NA) NA Conclusion Vascular malformations can be classified into various subtypes (capillary, venous, arterial, lymphatics, etc), found throughout the body, and vary in size. Our case consists of a mixed nature (artery, vein, and lymphatics), notable size (9.0 cm in greatest dimension) with extensive bowel wall involvement, and an unusual location (rectosigmoid region). This case represents an uncommon presentation of this entity, which appears to be clinically challenging. Though uncommon, this diagnosis should be on the differential of unusual etiologies of overt lower GI bleeding.

Prophylactic Proton Pump Inhibitors in Upper Gastrointestinal Bleeding: Impact and Underprescription in a French Multicentric Cohort.

Appropriate prescription of Proton pump inhibitors (PPIs) remains an important concern amid the rising overuse. A gap exists in the literature regarding the benefit of PPI prophylaxis and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB). This study aims to describe the characteristics of hemorrhage in relation to PPI use in patients experiencing UGIB, with a focus on high-risk individuals requiring gastroprotection. Data from a French multicentric cohort of patients experiencing UGIB were analyzed. Patients using PPI were compared to those without PPI considering bleeding etiologies and outcomes of peptic ulcer disease (PUD)-related hemorrhage. The rate of PPI use and its effect on bleeding characteristics in high-risk populations, defined based on international guidelines, were also assessed. Among 2497 included patients, 31.1% were on PPI at bleeding onset. PPI users exhibited a significantly lower rate of PUD-related bleeding in comparison with those without PPI (24.7 vs 40.8%, respectively, p < 0.0001). Similar difference was observed in high-risk populations, of whom, only 40.3% had gastroprotection with PPI before bleeding onset. PPI prophylaxis, however, did not influence the severity of bleeding in the general study population or in high-risk groups. Multivariate analysis identified age, comorbidities, and having more than two anti-thrombotic agents as predictors of severe bleeding. PPI users appear to have a lower rate of bleeding ulcers compared to non-users. However, underprescription in high-risk groups raises the need for standardized care to ensure appropriate PPI use.

7917 Bilateral Adrenal Hemorrhages As The Initial Presentation Of Poorly Differentiated Bronchogenic Carcinoma

Abstract Disclosure: B. Malapur: None. M.G. Jakoby: None. V. Williams: None. Introduction: Bilateral adrenal hemorrhage is rare, and most cases occur in the setting of bacterial sepsis, coagulopathies such as antiphospholipid antibody syndrome, treatment with anticoagulants, surgery, or trauma. We present a patient with asynchronous bilateral adrenal hemorrhages that resulted in an eventual diagnosis of poorly differentiated bronchogenic carcinoma. Case: A 65-year-old female smoker was found to have a large right adrenal hematoma on computed tomography (CT) obtained for evaluation of acute onset right flank pain. No hemorrhage or anatomic abnormalities of the left adrenal gland were apparent, and the patient was discharged home after her pain was controlled. Approximately one month later, she returned to hospital with bilateral flank pain, and bilateral adrenal hemorrhages were diagnosed on repeat CT imaging. An 8 cm left upper lobe lung mass was revealed on a chest CT scan, and cytology from a bronchoscopic biopsy confirmed poorly differentiated bronchogenic carcinoma. The patient had no recent surgeries, abdominal trauma, or treatment with anticoagulants, serologic evaluation for coagulopathies and disseminated intravascular coagulation was unremarkable, blood cultures failed to grow bacterial pathogens, and acid-fast staining of lung tissue was negative. The patient was discharged from her second hospital admission on hydrocortisone and fludrocortisone. Discussion: Adrenal hemorrhage in the setting of malignancy is usually a complication of adrenal metastases. The prevalence of adrenal metastases in advanced stage cancer is approximately 3%, with lung and breast cancers and melanoma showing the highest predilection for adrenal metastases. This case is unusual because the patient had no focal masses or disruption of left adrenal contour on CT to indicate adrenal metastases at the time of right adrenal hemorrhage, and she did not have other established risk factors for pathologic bleeding in the setting of malignancy such as thrombocytopenia or treatment with chemotherapy agents, anticoagulants, or nonsteroidal anti-inflammatory drugs. Adrenal hemorrhage is also a rare inciting event resulting in the diagnosis of lung cancer; to date, there are only 29 published cases of spontaneous adrenal hemorrhage as the initial presentation of lung cancer. This case illustrates the importance of careful evaluation for malignancy in patients with spontaneous adrenal hemorrhage and no clear etiology for adrenal bleeding. Presentation: 6/1/2024

Clinical approach to the diagnosis and management of small bowel bleeding.

The diagnosis and management of small bowel bleeding (SBB) can be a clinical challenge. Advances in video capsule endoscopy, balloon-assisted enteroscopy, and multiphasic computed tomography allow for localization and therapeutic intervention. Etiologies of SBB including vascular, neoplastic, and inflammatory conditions are associated with age and comorbidities. The present review highlights terminologies that describe SBB, provides a differential diagnosis for bleeding etiologies, and summarizes a clinical approach to managing this condition.

First-Trimester Vaginal Bleeding and Adverse Obstetric Outcomes in a Semi-urban Population of India: A Prospective Observational Study.

Background This study aimed to investigate the obstetric outcomes in antenatal women with first-trimester vaginal bleeding. Methodology This single-centered, prospective, observational study was conducted in a tertiary healthcare institution. Antenatal women with first-trimester vaginal bleeding who visited the hospital were screened for eligibility and included in the study. They were followed up until the termination of pregnancy or delivery based on the etiology of vaginal bleeding. Various fetomaternal outcomes such as pregnancy outcomes, obstetric complications, mode of delivery, and neonatal outcomes were analyzed. Results This study included 120 antenatal women who experienced first-trimester vaginal bleeding during the study period. Vaginal bleeding was more prevalent in the age group of 25-34 years and primigravidas. Out of 120 women, 14 (11.6%) either aborted or the pregnancy was terminated as a result of a nonviable gestation, and 106 (88.4%) delivered after the period of viability. Out of 106 women, 56 (52.8%) had full-term pregnancies without any obstetric complications. We analyzed the obstetric complications developed in all the study participants and found that 23 (21.7%) had preterm labor, 12 (11.3%) had placental abruption, 6 (5.7%) had premature rupture of membrane, 4 (3.9%) had anemia, and 2 (1.9%) developed hypertensive disorder of pregnancy. Of all deliveries, 54 (50.9%) delivered vaginally and 52 (49.1%) had cesarean delivery. There were no major adverse neonatal outcomes in terms of birthweight, APGAR score at one minute, and APGAR score at five minutes. Conclusions A large proportion of antenatal women with first-trimester vaginal bleeding can have favorable perinatal outcomes. However, as a few may develop obstetric complications, regular follow-up of such cases is mandated to prevent adverse outcomes.

Etiologies of Abnormal Uterine Bleeding using PALM-COEIN Classification at A Tertiary Care Hospital in North Karnataka- A cross-sectional study

Etiologies of Abnormal Uterine Bleeding using PALM-COEIN Classification at A Tertiary Care Hospital in North Karnataka- A cross-sectional study

Gastrohepatic Fistula Secondary to Metastatic Colon Cancer as a Rare Etiology of Upper Gastrointestinal Bleed.

Gastrohepatic Fistula Secondary to Metastatic Colon Cancer as a Rare Etiology of Upper Gastrointestinal Bleed.

Unveiling Dieulafoy’s Lesion: A Case Report on Upper Gastrointestinal Bleeding Caused by Dieulafoy’s Lesion

Dieulafoy’s lesion is a rare entity, mostly found in stomach (53%), followed by the duodenum or jejunum (33%) and lastly colon or rectum (13%). Although relatively infrequent, Dieulafoy’s lesion indicates an important etiology of acute gastrointestinal bleeding because of its predisposition to cause massive, life-threatening and recurrent bleeding. We report a female patient with clinical presentation of hematemesis and melena for 2 day’s duration.

A case report of non hodgkin lymphoma presenting with upper gastrointestinal tract bleeding

Abstract: Initial evaluation of patients with acute gastrointestinal (GI) tract bleeding includes assessment of hemodynamic stability and resuscitation if necessary Case Report: A 48-year-old male patient was admitted to the emergency department with complaints of dizziness, intense weakness, vomiting in the form of coffee grounds and black diarrhea Conclusion: Aggressive non-hodgkin lymphoma may be among the etiologies of upper gastrointestinal bleeding. In cases where endoscopic and surgical methods are inadequate, chemotherapy may be a life-saving option considering the possible risks.

Upper Gastrointestinal Bleeding in the Emergency Department of Ibn Sina Hospital in Rabat: Etiological, Endoscopic, Therapeutic and Evolutive Aspects

Introduction: Upper gastrointestinal bleeding (UGIB) is defined as a bleeding from a lesion in the digestive tract located upstream of the duodenojejunal angle of Treitz. It is a medical emergency with a mortality ranging from 2 to 10%. The aim of the study is to investigate the main etiologies of upper gastrointestinal bleeding in our setting, and specify the main endoscopic findings, therapeutic approaches, and evolutive aspects. Materials and methods: A prospective, descriptive study conducted over an eight month period from May 1st to December 1st, including 50 adult patients admitted for UGIB who underwent conclusive esophagogastroduodenoscopy (EGD). We collected data about patients demographics, comorbidities, clinical presentaiton, physical examination findings, laboratory data, EGD results, therapeutic procedures and patient outcomes. Results: UGD represented 0.5% of emergency admissions, with a mean age of 61.22 years and no gender predominance. The main risk factors were related to the use of anticoagulants and/or antiplatelet agents, a history of chronic liver disease, chronic gastritis, and alcohol and tobacco use. Patients presented with hematemesis, melena, or both. EGD was performed in all patients, the main etiologies were peptic ulcer disease, vatical pathology and peptic pathology. Endoscopic treatment was performed in 38% patients, surgery was required in one case. Red blood cell transfusion was necessary in 83% patients. A favorable outcome was observed in 84% patients, while 16% patients died because of hemorrhagic shock, cardiogenic shock, and one case of multiple myeloma. Conclusion: UGIB remans a common medical and surgical emergency in our setting. The etiologies are dominated by peptic ulcer disease. EGD is the key investigation, with a diagnostic, therapeutic, and prognostic interest. The outcome was generally favorable in our study, except for 16% of cases who resulted in death. Preventive measures are essential.

A prospective study of endometrial histopathology in post-menopausal women in Jharkhand.

Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal fibroids are common etiologies of post menopausal bleeding. The most common cause of postmenopausal bleeding is endometrial atrophy, comprises of 60-80%, while endometrial hyperplasia and endometrial cancer contribute to only 11% of Post menopausal bleeding. The aim of study is to analyses histomorphological pattern of endometrium in patients presenting with post-menopausal bleeding in Jharkhand. 103 postmenopausal women presenting to tertiary center of Jharkhand in 2020-22 with bleeding were subjected to endometrial curettage for histopathology. Analysis is based on morphological criteria to assess endometrium. Endometrial histology is of four categories: Proliferative, Secretory, premalignant and carcinoma. The highest incidence of postmenopausal bleeding was noticed in age group of < 60 years and incidence of malignancy was higher after 57 years of age. The majority of patients had parity between 1 and 3 (78.6%). Malignant & premalignant lesions comprises about 22.3% among that 77.7% were due to benign causes. Among the benign causes of postmenopausal bleeding, proliferative endometrium was the commonest finding. Types of hyperplasia encountered were simple hyperplasia without atypia (6.8%), Complex hyperplasia without atypia (3.9%),Complex hyperplasia with atypia (4.8%) and Simple hyperplasia with atypia (4.8%). 21.4% of cases of postmenopausal bleeding were associated with atrophic endometrium. Secretory endometrium seen in 17.5% of women. Endometrial carcinoma accounted for 12.6% of cases of postmenopausal bleeding. Out of these 69.2% were of endometroid type of endometrial carcinoma, 15.3% were of papillary serous carcinoma and 15.3% had clear cell carcinoma. The mean age of patients with endometrium carcinoma was 62.3 years. All cases of endometrial carcinoma were associated with 1 or more risk factor like diabetes/hypertension/Nulligravida. Proliferative Endometrium was a major cause of postmenopausal bleeding. Among the malignant causes, endometrial adenocarcinoma of endometroid type was most frequent with a lower mean age at presentation than other high grade cancers like papillary serous carcinoma & clear cell carcinoma.

Review article: Upper gastrointestinal bleeding - review of current evidence and implications for management.

Acute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital-based care. Advances in care across pre-endoscopic, endoscopic and post-endoscopic phases have led to improvements in clinical outcomes. To provide a detailed, evidence-based update on major aspects of care across pre-endoscopic, endoscopic and post-endoscopic phases. We performed a structured bibliographic database search for each topic. If a recent high-quality meta-analysis was not available, we performed a meta-analysis with random effects methods and odds ratios with 95% confidence intervals. Pre-endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high-risk stigmata, endoscopic therapy, including over-the-scope clips (OTSCs) and TC-325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post-endoscopic management includes early enteral feeding for all UGIB patients. For high-risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high-risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered. Management of acute UGIB should include treatment plans for pre-endoscopic, endoscopic and post-endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.

Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit.

Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking. The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding. Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3h) or following (< 3h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards. A total of 68 patients (38 men, median age 69years [range 25-96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5-87.3), 40% (95% CI: 5.3-85.3), and 75% (95% CI: 63.0-84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2-97.5) and 79% (95% CI: 66.8-88.3), respectively. Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.

Evaluation of clinical and laboratory parameters of patients with the diagnosis of upper gastrointestinal system bleeding

Aims: In this study, it was purposed to evaluate demographic, clinical, laboratory characteristics, bleeding etiologies, risk factors, comorbidity and mortality of the patients who were interned with the diagnosis of upper gastrointestinal system bleeding. Methods: In this study, 157 patients those hospitalized to Ministry of Health Beyoğlu Public Hospitals Association Gaziosmanpaşa Taksim Training and Research Hospital Internal Medicine Clinic with the diagnosis of upper gastrointestinal bleeding between 1 April 2014 and 1 April 2015 were evaluated retrospectively. Age, gender, duration of hospitalization, comorbidity, prescription story, need and amount of transfusion, endoscopic findings, hemoglobin (Hgb), blood urea nitrogen (BUN), urea, creatinine (Cr) values on admission, complication and mortality data were recorded. IBM SPSS (Statistical Package for Social Sciences) for MAC 21.0 program was used for statistical analysis in order to evaluate the data. Results: Patient were aged between 17 and 94 .The mean age was 59.04±20.55. 95 (68.35%) of patients were male and 44 (31.65%) were female with the male/female ratio of 2.15/1. While 64.75% of the patients in our study had at least one additional disease, no additional disease was detected in 35.25%. Endoscopic procedure was peformed 89.93% of patients for both diagnosis and treatment. Exitus was seen in 7 patients and mortality was detected as 5.04%. Median age of deceased patients was 75.28±15.39. Median age of surviving patients was 58.18±20.47. Conclusion: Our study revealed that upper GI bleeding is an important cause of mortality and morbidity despite advanced treatment options and intensive care conditions. The most important risk factors responsible for mortality are advanced age and the presence of comorbidities, as seen in our study.

Systematic review and meta-analysis of the etiology of heavy menstrual bleeding in 2,770 adolescent females

BackgroundAdolescent heavy menstrual bleeding(HMB), menorrhagia or abnormal uterine bleeding commonly occur in adolescent women. The differential diagnosis can be challenging. The pneumonic: PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified), is commonly used but it does not stratify as to the likelihood of a disorder. We have sought to develop a probability-based differential diagnosis for Adolescent HMB, menorrhagia or abnormal uterine bleeding.MethodsA comprehensive literature search was conducted using PubMed, EMBASE, and SCOPUS databases. Case series describing adolescents from 10–19 years of age with HMB, menorrhagia or abnormal uterine bleeding was acceptable if: more than 10 patients were included; editorials, case reports, and secondary sources such as review articles, or book chapters were excluded. No language filter was used, but an English abstract was required. The etiology of HMB, menorrhagia or abnormal uterine bleeding, and the country of origin was extracted from articles that met inclusion criteria. Cumulative rate estimates were determined by Bayesian probability modeling.ResultsSeventeen full text articles were reviewed in detail; 2,770 patients were included. The most frequent causes of HMB were Ovarian Uterine Disorders (23.7%; 95% CredI 22–25.5%), Coagulation Disorders (19.4%; 95% CredI 17.8—21.1%), and Platelet Disorders (6.23%; 95% CredI 5.27–7.27%) with 45.9% (95% CredI 43.8—47.%9) of the cases of indeterminate origin.ConclusionsThe leading causes of HMB in healthy adolescent females were varied. The sub-analysis identified distinct etiologies, suggesting that multiple factors must be considered in the evaluation of HMB. While PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) provides us with a comprehensive picture of the possible causes of HMB in females, this systematic review assigns probabilities to the etiologies of HMB in adolescent females, providing physicians with a more focused and efficient pathway to diagnosis.

High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan.

The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy. We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6 % received endoscopic treatment. 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5 % vs. right colon 28.6 %) and etiologies (diverticular bleeding 27.5 % vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49-0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95 %CI 0.29-0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95 %CI 0.41-0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.

An Unusual Cause of Factor 7 Deficiency Causing Subgaleal Bleed in a Preterm Extremely Low Birth Weight Neonate

Intracranial hemorrhage is a known complication in preterm neonates. We present an unusual etiology of subgaleal bleeding in a preterm extremely low birth weight neonate secondary to factor 7 deficiency. The neonate had unexplained subgaleal bleeding at the time of birth and developed a life-threatening pulmonary bleed subsequently and expired before the administration of definitive therapy.

Awareness and Knowledge Among Medical Students Regarding Lower Gastrointestinal Bleeding Etiologies in Riyadh, Saudi Arabia

Awareness and Knowledge Among Medical Students Regarding Lower Gastrointestinal Bleeding Etiologies in Riyadh, Saudi Arabia

Age-specific causes of upper gastrointestinal bleeding in children.

The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.