Info

Push Enteroscopy with overtube

Treat

Alarm symptoms: abd pain, symptoms of subacute obstruction

No alarm symptoms or contraindications i i

Small bowel follow-through

CD/Ulcerations: Medical treatment, biopsy

Small bowel follow-through

CD/Ulcerations: Medical treatment, biopsy

Wireless Capsule Endoscopy

Wireless Capsule Endoscopy i

AVMs: Endoscopic and/or pharmacologic tx (hormones)

Other lesions: Tumors, strictures

Continued bleeding -►

AVMs: Endoscopic and/or pharmacologic tx (hormones)

Intaoperative Enteroscopy (IOE)

FIGURE 59-1. Schematic approach to obscure gastrointestinal bleeding. abd = abdominal; AVM = arteriovenous malformations; CD = Crohn's disease; EGD = esophagogastroduodenoscopy; NSAIDs = nonsteroidal anti-inflammatory drugs.

overtube), as well as experience, affect the depth of insertion. Regardless of technique the overall yield of diagnosis using enteroscopy in patients with OGIB is 30 to 50%. Enteroscopy has higher diagnostic yield compared with small bowel radiography and, thus, we feel that enteroscopy should be performed earlier in the evaluation of OGIB. Although this order has not been compared in randomized trials, it is generally accepted as standard of care (Zuckerman et al, 2000.)

Sonde enteroscopy permits more distal examination of the small bowel. Its insertion depth and amount of mucosa examined depends on intestinal motility. Lengthy examination, patient discomfort, and lack of therapeutic capabilities make this technique impractical and largely abandoned.

Until recently, intraoperative enteroscopy has been the most complete, direct diagnostic modality available for the evaluation of OGIB. It is also the most invasive and is generally reserved for patients with severe, recurrent GI bleeding in which the source remains obscure after complete, exhaustive examination. It has the considerable advantage of allowing complete small bowel examination while also directing therapy. Invariably, mucosal trauma causes artifact bleeding, which may itself obscure potential bleeding sites. Its yield varies from 77 to 87% (Bashir and Al-Kawas, 1996) and is dependent on technical expertise of the surgeon and endoscopist. To minimize artifact, the lumen should be examined in anterograde fashion as the bowel is manipulated over the scope. Potential bleeding sites identified by the endoscopist in the intestinal mucosa or on the intestinal serosa by the surgeon are marked with sutures for subsequent resection.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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