Unusual causes of gastrointestinal bleeding in the intensive care unit through the radiology lens.

The great majority of patients admitted to the intensive care unit (ICU) for critical gastrointestinal bleeding (GIB) will have a predictable etiology. Once the site is localized to the upper versus the lower gastrointestinal tract, the number of typically encountered etiological possibilities is quite limited. On rare occasions, the cause of GIB requiring ICU care is not one of the standard considerations, potentially leading to diagnostic and therapeutic delays. Within a short time period, three patients were admitted to our institution's medical ICU each with a different unexpected cause of GIB. All three cases generated a variety of instructive images, which are used in the present series to illustrate these conditions and the role of radiology in their evaluation and management.

Inflammatory bowel disease and cannabis: key counseling strategies.

PURPOSE OF REVIEW: Cannabis use is becoming more frequent in patients with inflammatory bowel disease (IBD). Because of the increased usage, gastroenterologists need to be cognizant of the benefits and risks associated with cannabis use in the IBD-patient population. RECENT FINDINGS: Recent studies have attempted to determine whether cannabis can improve biomarkers or endoscopic findings of inflammation in patients with IBD, but the results have been inconclusive. However, cannabis has been shown to have an impact on the symptoms and quality of life of individuals with IBD. Despite these benefits, the use of cannabis in IBD is not without risks, including the potential for systemic illness, toxin ingestion and significant drug interactions. SUMMARY: In this review article, we use a case-based approach to discuss the critical clinical data that informs us of the benefits and risks of cannabis use in IBD. The endocannabinoid system plays a crucial role in regulating various physiological functions including the gastrointestinal tract. Studies have investigated the impact of cannabis on various medical conditions, including IBD. Clinicians must be aware of the most recent data to properly educate their patients on the benefits and risks of its use.

The Pathogenesis and Clinical Management of Stricturing Crohn Disease.

Stricturing of the gastrointestinal tract is a common complication in Crohn disease and is a significant cause of morbidity and mortality among this population. The inflammatory process initiates fibrosis, leading to aberrant wound healing and excess deposition of extracellular matrix proteins. Our understanding of this process has grown and encompasses cellular mechanisms, epigenetic modifications, and inherent genetic predisposition toward fibrosis. Although medications can improve inflammation, there is still no drug to attenuate scar formation. As such, management of stricturing disease requires a multidisciplinary and individualized approach including medical management, therapeutic endoscopy, and surgery. This review details the current understanding regarding the pathogenesis, detection, and management of stricturing Crohn disease.

Stroke resulting from an isolated pulmonary arteriovenous malformation.

Isolated pulmonary arteriovenous malformations (PAVM) are rare, but can be responsible for paradoxical embolic events. It is important to recognise these situations early and intervene quickly to attain the best outcome. We describe the case of a 45-year-old woman with a long-standing history of migraines with aura who presented to the emergency department with left-sided weakness and slurred speech. Work-up was unclear and she was diagnosed with cryptogenic stroke. Follow-up transoesophageal echocardiogram was suggestive of an atrial septal defect, though no clear defect was evident. Pulmonary angiography revealed an isolated PAVM arising from the right lower lung segmental artery with a 2 mm feeding artery leading into 3-4 mm of dysplastic vessel that connects to the vein. The vessel was embolised successfully using a combination of a 4 mm Amplatzer Vascular Plug in the distal feeding artery and a 4 mm Nester coil proximally.