Subject(s)
Bacterial Infections/transmission , Endoscopes/microbiology , Endoscopes/virology , Endoscopy, Gastrointestinal/adverse effects , Technology Assessment, Biomedical , Virus Diseases/transmission , Bacterial Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Disinfection/methods , Endoscopes/adverse effects , Endoscopy, Gastrointestinal/methods , Equipment Contamination/prevention & control , Evaluation Studies as Topic , Humans , Risk Assessment , United States , Virus Diseases/prevention & controlSubject(s)
Endoscopes , Endoscopy, Gastrointestinal/methods , Hemostatic Techniques/instrumentation , Endoscopes/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Equipment Design , Equipment Safety , Health Care Costs , Hemostatic Techniques/economics , Humans , Sensitivity and Specificity , Technology Assessment, Biomedical , United StatesABSTRACT
The ischemic bowel diseases are a heterogeneous group of disorders usually seen in elderly individuals. They represent ischemic damage to different portions [figure: see text] of the bowel and produce a variety of clinical syndromes and outcomes. Colonic ischemia is the commonest of these disorders and has a favorable prognosis in most cases. In contrast, acute mesenteric ischemia, most commonly caused by a superior mesenteric artery embolus, is a disease with a poor prognosis. Acute mesenteric ischemia secondary to nonocclusive mesenteric ischemia usually is a [figure: see text] catastrophic complication of other severe medical illnesses, most notably atherosclerosis. Proper diagnosis and management of patients with ischemic bowel disease requires vigilance on the part of the physician and a willingness to embark on an aggressive plan of diagnosis and management in the appropriate setting.
Subject(s)
Ischemia/etiology , Splanchnic Circulation , Age Factors , Aged , Aged, 80 and over , Algorithms , Arteriosclerosis , Colon/blood supply , Humans , Ischemia/diagnosis , Ischemia/therapy , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Vascular Occlusion/etiology , Mesenteric Vascular Occlusion/therapy , Mesenteric Veins , Radiography , Thrombosis/etiologySubject(s)
Anesthetics, Intravenous/administration & dosage , Endoscopy, Gastrointestinal/methods , Premedication/standards , Propofol/administration & dosage , Technology Assessment, Biomedical , Anesthetics, Intravenous/adverse effects , Anesthetics, Intravenous/economics , Female , Humans , Male , Pain Measurement , Patient Satisfaction , Propofol/adverse effects , Propofol/economics , Randomized Controlled Trials as Topic , Sensitivity and SpecificityABSTRACT
OBJECTIVE: It is widely believed that Clostridium difficile (C. difficile)-associated diarrhea is a more severe disease in the elderly than in the young, associated with increased morbidity and mortality. These beliefs are largely anecdotal, and there are few data supporting them. METHODS: We conducted an evaluation in an urban, tertiary care hospital of 89 inpatients in whom C. difficile-associated diarrhea was identified. These patients were evaluated prospectively, and the group was divided by age into those < 60 yr of age (younger) and those > or = 60 yr (elderly). RESULTS: There was no difference in mortality or morbidity in elderly individuals with C. difficile-associated diarrhea when compared with younger persons similarly infected. The response to standard treatment was similar in both groups. Older patients were more likely to have an elevated white blood cell count in association with C. difficile-associated diarrhea (60% vs 26%, p < 0.05), and were more likely to have acquired their infection in the hospital (89% vs 50%, p < 0.0001). CONCLUSIONS: In the elderly, C. difficile-associated diarrhea is almost always acquired in institutions, and may not be obvious among patients' other problems. The elderly do not seem to have an increase in C. difficile diarrhea-associated morbidity or mortality. There is no evidence that C. difficile-associated diarrhea is more severe in the elderly than it is in the young.
Subject(s)
Aging/physiology , Clostridioides difficile , Clostridium Infections/physiopathology , Diarrhea/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Clostridium Infections/transmission , Cross Infection/transmission , Diarrhea/drug therapy , Follow-Up Studies , Humans , Leukocyte Count , Metronidazole/therapeutic use , Middle Aged , Prospective Studies , Recurrence , Survival Rate , Urban HealthABSTRACT
Colonic ischemia encompasses a wide clinical spectrum from mild, reversible disease to severe, irreversible injury. It is a frequent disorder of the large bowel in the elderly, and can mimic certain diseases such as inflammatory bowel disease and neoplasms. The clinical course is variable, but often includes crampy, lower abdominal pain and the passage of red or maroon blood mixed with stool. In most cases, management is expectant, with supportive care and attention for signs of complicated disease. Prognosis typically is favorable, with a majority of patients completely resolving their illness; a minority go on to develop irreversible injury including strictures and chronic segmental colitis. Successful management of a patient with ischemic colitis requires a high degree of clinical suspicion, early diagnosis, careful follow-up, and prompt recognition of persistent disease.
Subject(s)
Colon/blood supply , Ischemia/etiology , Colitis, Ischemic/diagnosis , Colitis, Ischemic/etiology , Colitis, Ischemic/therapy , Diagnosis, Differential , Humans , Ischemia/diagnosis , Ischemia/therapyABSTRACT
Gastrointestinal (GI) bleeding is an uncommon manifestation of AIDS despite the frequent involvement of the GI tract by infections, malignancies, and a variety of other disorders. GI bleeding may occur from a variety of causes, some specifically associated with AIDS and others unrelated to immunocompromise; most patients with AIDS who have lower GI bleeding have causes attributable to AIDS-specific lesions. Just as in an incompetent patient, an aggressive approach to diagnosis and treatment of GI bleeding in AIDS patients is warranted.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Gastrointestinal Hemorrhage , Diagnosis, Differential , Embolization, Therapeutic , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic , Humans , SclerotherapySubject(s)
Abdomen/surgery , Gastric Emptying/physiology , Intestinal Obstruction/etiology , Postoperative Complications , Cisapride , Dopamine Antagonists/therapeutic use , Erythromycin/therapeutic use , Gastrointestinal Agents/therapeutic use , Humans , Intestinal Obstruction/diet therapy , Intestinal Obstruction/prevention & control , Intubation, Gastrointestinal , Metoclopramide/therapeutic use , Parasympathomimetics/therapeutic use , Piperidines/therapeutic use , Postoperative Complications/diet therapy , Postoperative Complications/prevention & control , Protein Synthesis Inhibitors/therapeutic useSubject(s)
Gastric Emptying , Intestinal Pseudo-Obstruction/physiopathology , Postoperative Complications/physiopathology , Anesthesia/adverse effects , Gastric Emptying/physiology , Humans , Intestinal Pseudo-Obstruction/etiology , Intestinal Pseudo-Obstruction/metabolism , Laparoscopy/adverse effects , Laparotomy/adverse effects , Pain, Postoperative/complications , Postoperative Complications/etiology , Postoperative Complications/metabolismABSTRACT
This infection first surfaced as a U.S. public health problem in the early 1980s. The problem persists, in the United States and elsewhere. Illness may resemble that in other infectious colitides and should be considered in the differential diagnosis of ischemic colitis. Prompt diagnosis may be made by specific stool culture.
