Other Lesions

Dieulafoy's lesions account for 0.3 to 6.8% of acute upper GI bleeds. In a series of 40 Dieulafoy lesions, 80% were located in the stomach and 17.5% in the duodenum (Schmulewitz and Baillie, 2001). Combination therapy (injection therapy plus thermocoagulation) was successful in 36 patients (90%). Mallory-Weiss tears account for 4.5 to 11% of cases of NVUGIB. Most stop bleeding spontaneously; however 14 to 30% have needed surgery or other therapies which now have been supplanted by endoscopic therapy. Cameron's lesions are usually associated with iron deficiency anemia but may present as acute NVUGIB in up to 33% of cases. Neoplasms and postpolypectomy bleeds are other common causes.The endoscopist must maintain a broad differential diagnosis to appropriately manage bleeding lesions. Figure 28-2 illustrates a sentinel bleed from an aneurysm of the gastroduodenal artery that would have been inadequately managed with just a hemoclip.

FIGURE 28-2A. Sentinel bleed from an aneurysm of the gastrodo-denal artery protruding into the duodenal cap.

FIGURE 28-2B. A single hemoclip applied to the lesion shown in Figure 28-2A.

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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