Etiology Of Bleeding Research Articles

Superior mesenteric arteriovenous fistula embolization with a vascular plug for upper gastrointestinal hemorrhage: a case report

BackgroundSuperior mesenteric arteriovenous fistula is a rare vascular anomaly often presenting with sequelae of portal hypertension, heart failure, or mesenteric ischemia. This report describes a patient with a previously unidentified superior mesenteric arteriovenous fistula who presented with variceal bleeding, thought to be the leading cause of mortality associated with this condition. Although this patient was initially referred for a transjugular intrahepatic portosystemic shunt procedure, following a thorough review of her clinical history and imaging, she instead underwent embolization of the arteriovenous fistula likely responsible for her symptoms.Case PresentationA 75-year-old woman with a past surgical history of extensive small bowel resection presented with active variceal bleeding requiring transfusions. She was referred to vascular and interventional radiology for transjugular intrahepatic portosystemic shunt procedure; however, her clinical presentation was inconsistent with cirrhosis. This prompted a further review of her imaging, which identified a superior mesenteric arteriovenous fistula as the probable etiology of her varices. This fistula was subsequently embolized with a vascular plug and follow-up upper endoscopy at 1-month demonstrated complete resolution of her varices.ConclusionsThis report highlights a potential etiology of variceal bleeding in the acutely ill patient. Through a thorough consultation, the patient described here was able to avoid a procedure with the potential to cause catastrophic consequences, and instead receive the appropriate treatment for an uncommon condition.Level of EvidenceLevel 4, Case Report.

An Unusual Cause of Vulvar Hemorrhage: About 12 Cases

Vulvar or genital hemorrhage is an alarming reason for consultation that worries parents a lot. Several etiologies of vulvar bleeding have been reported, including sexual abuse (common in our socioeconomic context) or urethral prolapse. Urethral prolapse is the complete eversion of the distal congestive urethral mucosa through the urinary sphincter. It is a benign condition that is uncommon in children and occurs in girls with a peak in frequency between the ages of four and six, mainly in the black population. The clinical presentation is dominated by vulvar bleeding, which therefore poses a medico-legal issue and a differential diagnosis with other causes of genital hemorrhage. The diagnosis is purely clinical, presenting as a more or less voluminous pink or purplish edematous circumferential pseudotumor bulge that bleeds spontaneously. No paraclinical examination is necessary. We retrospectively analyzed the records of 12 prepubertal patients aged between 5 and 12 years who consulted for genital hemorrhage either post-traumatic or spontaneous with urethral prolapse in the Pediatric Surgical Emergency urethral prolapse department, over a period of 18 years (1998 - 2020). In our series, the age of diagnosis ranged from 5 to 12 years with a median age of 08 years. Eleven patients were Caucasian and only one patient was from Senegal. Other causes of vaginal hemorrhage were ruled out, including sexual abuse or post-traumatic bleeding. The treatment of this affection is subject to great controversy, between surgical and conservative treatment, all our patients benefited from surgical treatment except one patient who benefited from medical treatment. The risk of complications, in particular urethral stenosis and recurrence, is not negligible in the face of poorly conducted medical treatment or surgery. In our series, the clinical outcome was favorable in all patients. The duration of hospitalization could be shortened by an early removal of the urinary catheter, .......

A Cohort Study to Compare Effects between Ulcer- and Nonulcer-Related Nonvariceal Upper Gastrointestinal Bleeding.

Objective The aim of this study was to better understand the characteristics and etiology of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) in recent years in this region and to provide evidence-based medical evidence. Methods 100 patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) who met the clinical diagnostic criteria of ANVUGIB admitted to Suzhou First People's Hospital from January 2017 to December 2021 were analyzed, as well as the age difference and change rule. According to age, 100 patients were divided into young (18-39 years), middle-aged (40-59 years), and elderly (60 years and above), and the differences in the three groups were compared. The etiology was confirmed by endoscopic examination and was recorded one by one in a well-designed ANVUGIB case data registration form. Statistical software SPSS 23.0 was used for analysis. Results Gastric ulcer was the main cause in the elderly group (50.0%), duodenal ulcer was the main cause in the middle and young groups, and gastrointestinal cancer (7.1%) and marginal ulcer (2.3%) in the elderly group were higher than those in the young group. Nonsteroidal anti-inflammatory drugs (52.3%) were the main inducement in the elderly group, which was significantly higher than in the middle-aged group (13.1%) and the young group (5%) (P < 0.01). Drinking, fatigue, and emotional excitement led to a higher proportion in the middle-aged group and the young group, in comparison to the elderly group (P < 0.01). Conclusion Peptic ulcer is the most common cause of acute nonvariceal upper gastrointestinal bleeding, followed by acute gastric mucosal lesions and upper digestive system tumors, compared with nonulcer.

Colonoscopic Evaluation of Per Rectal Bleeding in Children : Our Experience

Background: Most patients with Per Rectal Bleeding (PRB) warrant endoscopic examination of the lower GI tract. This study was done to determine the demographic profile and find out the etiology of bleeding per rectum under colonoscipic evaluation.&#x0D; Meterials and methods : In this study, we did a retrospective review of the clinical data of children between 0 and 18 years of age who presented with per rectalbleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Pediatric Gastroenterology &amp; Nutrition, Chattagram Maa-O-Shishu Hospital, Chattagram from July 2014 to July 2021.Patient demographics, clinical features and endoscopic and histopathological findings were recorded.&#x0D; Results: Overall, we included 111 patients with mean age 9.6±5.1 years. There were 69 (62.2%) male, 42(37.80%) female and with a male to female ratio of 1.64:1.0 The highest incidence was the age group of 11 to 18 years, 46 (41.40%). The most common colonoscopy finding were juvenile colorectal polyp 46 (41.44% ) which include rectal polyps 21 ( 18.9%), Sigmoid polyp 17 (15.3), recto sigmoid polyp 4 (3.6%), colonic polyp 4(3.6%), followed by internal hemorrhoids (20 cases, 18%) rectal ulcers (5 cases, 4.5%) colitis (4 cases, 3.60%) and findings suggestive of koach’s infection (2 cases, 1.8 %). All polyps were removed by colonoscopic polypectomy (47 cases 42.30%), 64 cases (57.65%) were given conservative treatment.&#x0D; Conclusion :We found that Juvenile colorectal polyps constitute the most common cause of per rectal bleeding in pediatric age group followed by hemorrhoids and colitis . Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding and it’s good for both diagnostic and therapeutic procedure.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 66-69

Differences in Presentation, Radiological Features, and Outcomes in Traumatic Versus Spontaneous Acute Subdural Hematomas—A Single-Institution Population-Based Study

Spontaneous acute subdural hematoma (sASDH) is a rare neurosurgical condition, with the literature mainly consisting of case reports. In the present study, we compared sASDH with traumatic ASDH (tASDH) to determine the differences in presentation, radiological features, and outcomes in a population-based setting. All adult patients (age ≥18 years) who had undergone surgery for ASDH (n= 266), either spontaneous or traumatic, from 2010 to 2020 were included retrospectively. The cohort was divided into 2 groups for comparative analysis: sASDH group (n= 24) versus tASDH group (n= 242). Of the 266 patients, 24 (9.0%) had presented with sASDH. The sASDH group had a mean age of 66.2 years, and sudden headache was the most common presenting symptom (83.3%). The sASDH group had a higher Glasgow coma scale score at presentation compared with the tASDH group (Glasgow coma scale scores, 10 and 8, respectively; P < 0.01). The outcomes, assessed using the Glasgow outcome scale (GOS), revealed a greater incidence of more favorable outcomes (GOS score 4-5) for the sASDH group (72.7%) than for the tASDH group (41.5%). In the present population-based study of surgically evacuated ASDH cases, 9% were spontaneous without previous trauma. The outcomes (GOS scores) were significantly more favorable for those with sASDH than for those with tASDH. In one half of the patients with sASDH, arterial bleeding was noted perioperatively, although the preoperative radiological examinations revealed no abnormalities for most patients. However, the lack of sufficient examinations such as computed tomography angiography made it difficult to establish the most common etiology of bleeding in those with sASDH. Further research is warranted to determine the reference standard method for the investigation of sASDH.

Etiology distribution of abnormal uterine bleeding according to FIGO classification system: A combined study of ultrasound and histopathology.

To classify the FIGO's PALM-COEIN etiology for abnormal uterine bleeding (AUB) patients according to the ultrasound and histopathology and to evaluate the etiology prevalence distribution for AUB patients. A total of 1065 women with AUB in the Second Hospital of Shandong University between January 2019 and March 2021. The intrauterine histopathological and ultrasound results were reviewed retrospectively.PALM-COEIN etiology classification was performed according to histopathology and ultrasound. The classification system was stratified into nine basic categories: Polyp (AUB-P), adenomyosis (AUB-A), leiomyoma (AUB-L), malignancy and hyperplasia (AUB-M), coagulopathy (AUB-C), ovulatory disorders (AUB-O), endometrium (AUB-E), Iatrogenic(AUB-I), and not classified (AUB-N). The number of cases and composition ratio were also calculated. According to the FIGO's classification system, the PALM group (656,61.60%), which were defined as structural entities that can be measured visually with ultrasound and/or histopathology. 176 (16.53%) patients were classified as AUB-P,102 (9.58%) patients were classified as AUB-A, 487(45.73%) patients were classified as AUB-L, 31 (2.91%) patients were classified as AUB-M. The COEIN group (409,38.40%), which were defined as nonstructural entities that cannot be measured by ultrasound and/or histopathology. Nobody were classified as AUB-C in our group, and 383 (35.96%) patients were classified as AUB-O, 4 (0.38%) patients were classified as AUB-E,14 (1.31%) patients were classified as AUB-I,8 (0.75%) patients were classified as AUB-N. In our study, AUB-L was the most common cause, followed by AUB-O, AUB-P, AUB-A, AUB-M, AUB-I, AUB-N, and AUB-E.PALM-COEIN etiology classification system played an important role in the epidemic and management standardization of AUB patients, provided an effective communication between physicians and researchers also. Ultrasonography was the preferred examination for AUB patients, especially with structural abnormalities.

Application of Argon Plasma Coagulation for Gastrointestinal Angiodysplasia in Children- Experience From a Tertiary Center.

BackgroundArgon plasma coagulation (APC) has been applied in adults to treat various diseases, including vascular lesions in the gastrointestinal (GI) tract. However, angiodysplasia (AD) is an uncommon cause of pediatric GI bleeding, while the experience of treating AD with APC was rarely reported.MethodsFive children with AD in the GI tract successfully treated with APC were reviewed.ResultsThree of the five patients were girls, and the age at diagnosis ranged from 1.5 months to 10.5 years of age. One patient with gastric AD manifested with tarry stool, and the rest had colonic AD, which caused various degrees of bloody stool. Three patients had evident anemia. All patients received an endoscopic diagnosis, and two had compatible findings in radiographic exams. Each patient underwent one APC treatment session, and none encountered procedure-related complications or re-bleeding.ConclusionAD can be an etiology of GI bleeding even in neonates. APC is an effective and safe therapy for symptomatic AD in children.

Causes of Abnormal Uterine Bleeding in Females of Reproductive Age Group attending Gynaecology Dept of UOL Hospital

Background: Abnormal uterine bleeding is a prevalent problem that prompts a female to seek medical help. The most common symptom of abnormal uterine bleeding is heavy menstrual bleeding. The impact of abnormal uterine bleeding on one's quality of life is important. Aim: To determine the causes of abnormal uterine bleeding. Methods: This cross-sectional study was conducted at Department of Gyneacology University of Lahore Teaching Hospital Lahore over a period of one year from Nov 2020 to Nov 2021. Eighty females of reproductive age with Abnormal Uterine Bleeding were selected. All females were examined for the etiology of abnormal uterine bleeding. The females with menstrual blood loss lasting &gt;8 days, passage of blood clots or haemoglobin concentration &lt; l0 gm/dl were enrolled. The exclusion criteria includes the females less than 20 years of age, or with pubertal menorrhagia or postmenopausal females. Results: Out of total eighty females, 25% females belong to 42 years age group. The most prevalent etiology of abnormal uterine bleeding was fibroid uterus i.e. 62.5% cases, followed by adenomyosis (15%), endometrial polyp (10%) and endometrial hyperplasia (12.5%). Fifty females (50%) were multipara, 20 (25%) were grand multipara and 10(12.5%) were great grand multipara. Severe anemia was noted in almost 10 females (12.5%), moderate anemia in 56 cases (70%) and mild anemia in 14 cases (17.5%). Transabdominal scan was done to confirm the diagnosis of fibroid uterus, adenomyosis, endometrial hyperplasia and endometrial polyp. Conclusion: Fibroid uterus was the commonest cause in females presenting with abnormal uterine bleeding to University of Lahore Teaching Hospital affecting quality of life in females and causing psychological problems. Keywords: Abnormal uterine bleeding, Menorrhagia, Metrorrhagia, Fibroid uterus, Endometrial polyps.

Color Doppler Imaging of Vascular Abnormalities of the Uterus.

Many uterine abnormalities present clinically with bleeding encompassing a broad spectrum of patients from postmenopausal spotting to life-threatening hemorrhage. Color and spectral Doppler imaging of the pelvis is often the first crucial investigation used to quickly establish the correct etiology of the uterine bleeding and guide clinical decision making and patient management.

Hemoglobin Levels and Platelet Counts after Hysteroscopy Due to Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is a condition defined as all uterine bleeding that differs from physiological menstruation. The etiology of AUB has been classified by the International Federation of Gynecology and Obstetrics (FIGO). It includes structural categories, such as endometrial polyps, adenomyosis, leiomyomas, hyperplasia, and malignant neoplasms, and non-structural categories, i.e., hemorrhages due to congenital and acquired coagulopathies, ovarian dysfunction, disorders of the local endometrial hemostasis mechanism with normal organ structure, iatrogenic causes, and due to other poorly defined causes. This is a retrospective study based on the medical data of a group of 543 women aged 21–88 years (52.81 ± 11.79) (p < 0.01) hospitalized at the Gynecology and Obstetrics Department in Biała Podlaska, Poland. These patients underwent an hysteroscopy procedure due to excessive uterine bleeding of varied, FIGO-divided etiology. The results show the dependence of postoperative hemoglobin and platelet count on the etiology of bleeding and the age of the women. The majority of patients had normal hemoglobin and platelet counts after the procedure, while moderate anemia was the most common disorder. It occurred most frequently in patients undergoing hysteroscopy due to heavy menstrual bleeding.

The Risk of Endometrial Malignancy and Other Endometrial Pathology in Women with Abnormal Uterine Bleeding: An Ultrasound-Based Model Development Study by the IETA Group

Objectives: The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year. Methods: A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model’s ability to discriminate between the four outcomes and the calibration of risk estimates. Results: The median age in 2,417 women was 50 (interquartile range 43–57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85–0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers. Limitations: Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable. Conclusions: The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.

VARICEAL VERSUS NON-VARICEAL ETIOLOGY OF GASTROINTESTINAL BLEEDING IN PATIENTS WITH CIRRHOSIS AND RELATED SECONDARY COMPLICATIONS

Liver cirrhosis is a highly prevalent worldwide disease and in the last decade, there has been an increase of 13%. Patients with advanced liver disease are at higher risk of developing life-threatening decompensations; one of these main complications is the presence of upper gastrointestinal bleeding, representing a frequent cause of hospital admission and mortality. Broad knowledge of these complications is essential to improve the diagnostic and therapeutic approach in these patients. To compare the different complications related to upper gastrointestinal bleeding of variceal vs. non-variceal origin and the characteristics of these patients. Case-control study conducted in a cohort. The cohort was made up of cirrhotic patients due to any etiology who were admitted for hospitalization at our unit in a period from January 2017 to May 2021; two groups were extracted, those with variceal bleeding formed the cases group and, those with non-variceal hemorrhage the control group and a comparison between groups was made using X2 or Fisher's exact test or Student's test accordingly to the type and distribution of each variable, considering significant a value of p <0.01 A total of 294 cirrhotic patients with gastrointestinal bleeding were included, 169 men (57.5%); mean age 54.6 ± 11.9 years; mean days of hospital stay 2.19 ± 2.74. Regarding the etiology of liver cirrhosis, the main etiology was alcohol in 39.7% (117), followed by viral etiology in 6.4% (18), NASH in 5.8% (17) and, less frequently due to autoimmune causes in 3.4% (10), however, up to 44.7% remained with indeterminate etiology. Regarding the origin of gastrointestinal bleeding, 209 (71.1%) were of variceal origin and 85 (28-9%) were of non-variceal origin. A total of 94 (32%) developed acute kidney injury (AKI), and only the variceal origin was related to a higher risk of developing AKI 57/209 vs. 37/85, p <0.01 (OR = 1.6; 95% CI: 1.2-2.2) but there was no difference regarding the etiology of gastrointestinal bleeding and development of other complications such as encephalopathy, ascites, jaundice, infections, need a transfusion, severe hypovolemic shock, death. See table. The etiology (variceal vs. non-variceal) of the gastrointestinal bleeding has no impact on the development of other complications in cirrhosis; therefore, therapeutic prophylaxis and surveillance strategies should be prioritized in the patient with cirrhosis, regardless of the origin of bleeding. The risk of AKI should always be considered and monitored when the origin of the bleeding is variceal since this study shows the closest relationship between these two complications. The authors declare that there is no conflict of interest

Etiology of Upper Gastrointestinal Bleeding in the Children Admitted to Besat Hospital in Sanandaj

Etiology of Upper Gastrointestinal Bleeding in the Children Admitted to Besat Hospital in Sanandaj

Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists.

Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.

COVID-19 Pandemisinde Acil Servise Başvuran Üst Gastrointestinal Kanamalı Hastaların Sayısı Azaldı mı?: Tek Merkez Deneyimi

Objective: In the period of the coronavirus disease-19 (COVID-19) pandemic, upper gastrointestinal endoscopy was either postponed or canceled, except for emergencies, due to the high risk of transmission. Our study aimed to evaluate the effect of the COVID-19 pandemic on patients with upper gastrointestinal bleeding presenting to the emergency department and to compare it with the data before the pandemic. Material and Methods: In this single-center, retrospective study, patients were divided into 2 groups: pre-COVID-19 (pre-C) (March 2019-March 2020) and post-COVID-19 (post-C) (March 2020- March 2021). Patients who presented to the emergency department with upper gastrointestinal bleeding during these periods and underwent endoscopic examination were included in the study. Results: Endoscopy for upper gastrointestinal bleeding was urgently performed in 125 patients in the pre-C period and in 89 (29% decrease) patients in the post- C period. The Glasgow-Blatchford Score was higher in the pre-C period (p=0.02). Peptic ulcers were the most common cause of bleeding in both groups. High-risk peptic ulcer (forrest 1a/1b/2a/2b), and malignancy were observed more frequently in the post-C period (p=0.003, p=0.04; respectively). Endoscopic combined treatment rate was higher in the post-C group (p<0.001). Re-bleeding ratios were similar for both the groups (p=0.48). Conclusion: During the post-C period, the number of upper gastrointestinal bleeding cases admitted to the emergency department decreased significantly. However, the rate of high-risk peptic ulcer and malignancy in the etiology of upper gastrointestinal bleeding increased in the post-C period.

Intraoperative Bleeding Management: An Updating Literature Review: Review Article

Background: Intraoperative bleeding remains a major complication during and after surgery, leading to increased morbidity and mortality. Several influences determine the complex causes of bleeding in surgical patients. About 75 to 90% of early intraoperative and postoperative bleeding is due to technical factors. In some cases, however, acquired or congenital coagulopathies can stimulate, if not directly cause, surgical bleeding.&#x0D; Objectives: This paper aims to overview etiology, causes, diagnosis, and updated management of intraoperative bleeding.&#x0D; Methods: The review article ran from July 1, 2021 to October 31, 2021. We searched articles on etiology, causes, and treatments published in English worldwide in the Medline, EBSCO and PubMed databases. No software was used to analyze the data. Team members reviewed the data to determine initial results.&#x0D; Results: All patients scheduled for elective surgery should be screened for possible hemostatic defects using tests, and, if necessary, laboratory tests. Treatment of intraoperative bleeding consists of identifying patients at risk and understanding the effect of surgery on hemostasis. For patients at high risk of bleeding, a pre-operative meeting with a multidisciplinary team (anesthesiologist, surgeon, hematologist, radiologist) can discuss the correct surgical procedure.&#x0D; Conclusion: Technical variables account for 75-90% of initial intraoperative and postoperative bleeding. However, in other cases it is associated with acquired or congenital coagulation disorders. All patients scheduled for elective surgery should be checked for problems with hemostasis. Treatment of intraoperative bleeding involves identifying those at risk and understanding the effect of surgery on hemostasis.

Abnormal Uterine Bleeding in Adolescent

Abnormal uterine bleeding (AUB) is defined as the abnormal bleeding from the uterine corpus in term of duration, volume, frequency and/or regularity. This condition occurs in 37% of adolescents and may affect the quality of life and increased hospitalization. Etiology is divided into structural and non-structural causes, known as PALM-COEIN. The most common etiology in adolescents is anovulatory menstruation due to immature hypothalamus-hypophysis axis. Diagnostic evaluation should include investigation in the etiology of AUB, anemia signs, and hemodynamic status. Treatment of AUB consists of hormonal and non-hormonal therapy. Therapy in adolescent is given based on the severity of bleeding, grading of anemia, and hemodynamic stability. Follow-up is required after therapy. Understanding AUB in adolescents can help clinicians deliver appropriate and comprehensive treatment. This review was aimed to explain about definition, epidemiology, etiology, pathophysiology, diagnosis, and treatment of abnormal uterine bleeding in adolescent.

Abstract 9779: The Utility of Endoscopic Screening in Mitigating the Risk of Gastrointestinal Bleeding After Left Ventricular Assist Device Placement. A Retrospective Chart Review Study

Introduction: Left ventricular assist device (LVAD) is a lifesaving bridge to transplantation or destination therapy for patients with end-stage heart failure. More than one-third of patients suffer from gastrointestinal (GI) bleeding within one year of placement. We investigated the yield and safety of endoscopic screening for potential sources of GI bleeding before LVAD insertion. Hypothesis: Endoscopic screening prior to LVAD placement does not necessarily reduce the risk of GI bleed post LVAD. Methods: We performed a retrospective chart review study of patients at Saint Luke’s Mid America Heart Institute who underwent continuous-flow LVAD implantation from 2010 to 2020. Study participants were categorized based on whether or not they underwent screening endoscopy prior to LVAD implantation. Patients were followed for one year after implantation, and outcomes were collected to determine the yield and safety of these procedures. A multivariable logistic regression analysis was performed using SPSS® controlling for the following confounding factors: age, gender, race, and history of GI bleeding. Results: Among 205 patients with an LVAD, 169 patients were included in the study after excluding those with lack of data or those lost to follow up. 68 (40.23%) patients who received pre-LVAD screening by either upper and/or lower endoscopies, and 42 (24.85%) patients who had post-LVAD GI bleed. Patients who underwent pre-LVAD screening had similar rates of GI bleeding after LVAD compared to those who were not screened (odds ratio 1.66, 95% CI 0.648-4.264, P=0.2). Moreover, in patients with post LVAD GI bleed, endoscopy findings were typically different than those pre LVAD. No complications to the endoscopic interventions were reported. Conclusions: While endoscopic screening appears to be safe in patients before LVAD implantation, it had no association with GI bleeding risk or etiology after LVAD.

Heavy Menstrual Bleeding in Adolescent: Normal or a Sign of an Underlying Disease?

Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint among adolescents. During the first few post-menarcheal years, anovulatory cycles related to immaturity of the hypothalamic-pituitary-ovarian axis are the most common etiology for abnormal uterine bleeding and should be considered as a part of normal pubertal development rather than a disease. If an already regular menstrual cycle becomes irregular, secondary causes of anovulation should be ruled out. Inherited and acquired bleeding disorders, such as von Willebrand disease, and quantitative and qualitative abnormalities of platelets are relatively common findings in adolescents with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder in the family supports this etiology, warranting specialized laboratory testing. First-line treatment of HMB among adolescents is medical management with hormonal therapy or nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective tool also for all adolescents with menstrual needs.

Association between Shock Index and Emergency Department Cardiac Arrest.

Background In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED. Methods Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems. Results In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5–1.8). The aOR (CI) in the five etiologies was 1.3 (1.1–1.6) for hypoxia, 1.8 (1.6–2.1) for cardiac cause, 1.3 (0.98–1.7) for bleeding, 1.3 (1.03–1.6) for sepsis, and 1.9 (1.5–2.1) for other metabolic problems. Conclusion More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.