Hemorragia digestiva baja / Lower gastrointestinal bleeding

Lower GI bleeding originates distal to the angle of Treitz. Bleeding could be trivial or even massive and risky. It represents one third of the total of GI bleeding cases. It is more frequent in men and older patients. Its mortality is considered among 3-6 percent. It has worse prognosis if it begins during hospital stay. It is less severe than upper GI bleeding and stops spontaneously in 80 percent of cases. There is less consensus regarding its treatment than in case of upper GI bleeding. Nine percent is originated in the small bowel and 6 percent has an undetermined origin. It could be active, recent, or chronic. Acute: with less than 3 days of persistence, causing hemodynamic instability, anemia and/or need for blood transfusion. Chronic: any rectal slow or intermittent bleeding. The need for a transfusion or the occurrence of hemodynamic instability are rare. I tis necessary to identify the bleeding site, for therapy. It recurs in about 25 percent of cases. Colonoscopy is the most relevant study, allowing for diagnosis and localized therapy. Endoscopic hemostatic interventions are available with several options. “Haemospray” has merged as a modern promising new device. Noninvasive imaging studies are becoming more and more relevant and available, as well as interventional radiology for therapeutic purposes; a modern approach to this pathology. It helps to obtain information about bleeding activity, its anatomic origin, and also focuses the study, in order to perform endo-vascular therapy or suggests the localized endoscopy approach. This review represents our approach to the management of lower GI bleeding.

La hemorragia digestiva baja (HDB) se origina distal al ángulo de Treitz. Se puede presentar desde un sangrado trivial, hasta una hemorragia masiva con riesgo vital. La HDB representa un tercio de los casos de hemorragia gastrointestinal. Más frecuente en hombres y pacientes añosos. Tiene una mortalidad entre 3-6 por ciento. De peor pronóstico si se presentare durante la hospitalización. Menos grave que la alta cesa espontáneamente en 80 por ciento de los casos. Existe menos consenso terapéutico que en la hemorragia digestiva alta. El 9 por ciento se origina en el intestino delgado. En 6 por ciento de los casos no se puede determinar su origen. Puede presentarse como activa, reciente o crónica. Aguda: con menos de 3 días de evolución, que cause inestabilidad hemodinámica, anemia y/o necesidad de transfusión. Crónica: cualquier hemorragia a través del recto, con pérdida de sangre lenta o intermitente. La necesidad de transfusión o inestabilidad hemodinámica son raras. Es necesario identificar el sitio de sangrado para su terapia, ya que recurre en 25 por ciento de los casos. La colonoscopia es el estudio más relevante, que permite diagnóstico y terapia localizada. Existen intervenciones endoscópicas que permiten la hemostasia con varias opciones, a las que se agrega recientemente el Hemospray. Destaca el progresivo y relevante rol del estudio de imágenes no-invasivo en el enfrentamiento diagnóstico de la HDB, como gran avance en el enfrentamiento moderno de esta patología. Evidencia la actividad del sangrado, el origen anatómico, focaliza el estudio, y permite realizar terapia endo-vascular o focalizar la terapia endoscópica. El presente artículo, señala nuestra forma de enfrentar la HDB.

Application Value of 16-slice Spiral CT Angiography in Lower Extremity Arterial Disease / 医疗卫生装备

Objective To discuss the application value of 16-slice spiral CT in lower extremity angiography diagnosis of arteriosclerotic occlusive disease.Methods The 16-slice spiral CT was performed for 30 patients with disease of lower extremity to reconstruct maximal intensity projection(MIP),volume rendering technique(VR) and curved planar reconstruction(CPR).Results All the examinations of CTA were successful,abdominal aortic stenosis was 4 cases,Iliac artery stenosis was 6 cases,femoral artery stenosis was 8 cases and occlusion was 3 cases;lower leg arterial stenosis was 7 cases and occlusion was 2 cases.There are varying degrees of stenosis or occlusion in following femoral artery for all patients.Conclusion The 16-slice CT of lower extremity angiography can be an intuitive understanding of the extent and scope of lesions,and is a safe,accurate,non-invasive screening method in lower extremity artery.