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Bleeding in the Digestive Tract. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 8 p.

This fact sheet describes bleeding in the digestive tract, which is considered a symptom of a disease rather than a disease itself. Written in nontechnical language, the fact sheet answers common questions about digestive tract bleeding, including the signs, causes, diagnostic approaches, and treatment strategies. The signs of bleeding in the digestive tract depend upon the site and severity of bleeding. Vomiting bright red blood or material that looks like coffee grounds is a sign of bleeding in the upper digestive tract. When there is bleeding in the upper digestive tract or the small intestine, stool may be black and tarry or mixed with dark blood. Bleeding from the rectum or passing stool mixed with red blood is a sign of bleeding from the upper or lower digestive tract. A number of different conditions can cause bleeding in the digestive tract, including peptic ulcers, varices, Mallory-Weiss tears, gastritis, ulcers, cancer, diverticular disease, colitis, hemorrhoids, and polyps. The location and cause of the bleeding must be identified in order to implement the most appropriate treatment. Most causes of bleeding can be cured or controlled. Endoscopy is the most common tool for diagnosing and treating bleeding in the digestive tract. Readers are referred to two resource organizations for more information: the American College of Gastroenterology (www.acg.gi.org or 301–263–9000) and the American Gastroenterological Association (www.gastro.org or 301–654–2055). The fact sheet briefly describes the work of the National Digestive Diseases Information Clearinghouse, which provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. 1 figure. 2 tables. 1 reference.

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Colon: Questions and Answers. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 271-280.

This section of questions and answers is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. This section helps readers review seven chapters on the colon, including clinical aspects, therapy, extraintestinal manifestations and cancer, gastrointestinal infections, diverticular disease, colorectal neoplasms, irritable bowel syndrome (IBS), constipation, and disorders of the pelvic floor function. The section consists of 21 multiple choice questions, followed by annotated answers that explain each of the correct choices.

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Disorders of the Bladder, Prostate, and Seminal Vesicles. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 574-588.

This chapter about disorders of the bladder, prostate, and seminal vesicles is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The author begins by describing congenital anomalies of the bladder, including exstrophy, persistent urachus, and contractures of the bladder neck. The next section reviews acquired diseases of the bladder, including interstitial cystitis, internal vesical herniation, urinary incontinence, enuresis, foreign bodies introduced into the bladder and urethra, vesical manifestations of allergy, diverticula, vesical fistulas, perivesical lipomatosis, radiation cystitis, noninfectious hemorrhagic cystitis, and empyema of the bladder. A final brief section mentions congenital anomalies of the prostate and seminal vesicles, as well as bloody ejaculation. The chapter is illustrated with black-and-white drawings and photographs. The chapter concludes with an extensive list of references, categorized by topic. 3 figures. 197 references.

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Diverticulosis And Diverticulitis. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 8 p.

Many people have small pouches in their colons that bulge outward through weak spots; these pouches are also called diverticula. The condition of having these pouches is called diverticulosis. When the pouches become infected or inflamed, the condition is called diverticulitis or diverticular disease. The condition is characterized by pain and tenderness around the left side of the lower abdomen. This fact sheet describes diverticulosis and diverticulitis and the management of these conditions. Topics include the symptoms and complications of diverticulitis, which can include bleeding, abscess, perforation, peritonitis, fistula, and intestinal obstruction; the causes of diverticular disease, including the role of a low-fiber diet in causing the problem; diagnostic tests used to confirm the presence of diverticular disease, including medical history, abdominal ultrasound, and computerized tomography (CT) scan; treatment options, which usually involve dietary changes, bowel rest, and oral antibiotics; the role of dietary fiber and what foods have fiber; and when surgery might be necessary to treat diverticular disease. Many people with diverticulosis never have any discomfort or symptoms. For most people with diverticulosis, eating a high-fiber diet is the only treatment needed. Readers are encouraged to increase their fiber intake by eating whole-grain breads and cereals, fruits, and vegetables. The contact information for four resource organizations is provided. A final section describes the goals and work of the National Digestive Diseases Information Clearinghouse. 2 figures. 1 table.

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Gastrointestinal Infections, Clostridium Difficile- Associated Disease, and Diverticular Disease. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 223-240.

This chapter on gastrointestinal infections, Clostridium difficile-associated disease, and diverticular disease is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The authors focus on the more common infectious causes of diarrhea, food poisoning, and diverticulitis. The chapter first discusses viral infections, including rotavirus, caliciviruses, astrovirus, and enteric adenovirus. The chapter then considers bacterial causes of diarrhea, including Campylobacter, Salmonella, Shigella, Escherichia coli, Vibrio, and Yersinia. The next section considers parasitic infections, including those involving Giardia lamblia, Cryptosporidium, Entamoeba histolytica, and Blastocystic hominis. The chapter discusses traveler’s diarrhea, food poisoning, C. difficile-associated disease, and diverticular disease. C. difficile is described as a spore-forming toxigenic bacterium that causes diarrhea and colitis, typically after antibiotic therapy. Although in most cases the disease is mild and responds quickly to treatment, C. difficile colitis may be severe, especially if diagnosis and treatment are delayed. Symptoms of diverticulitis include lower abdominal pain, fever, and altered bowel habits––typically diarrhea. Treatment for diverticulitis is influenced by severity of the inflammation, ability to tolerate oral intake, previous history of diverticulitis or bleeding, and complications. 1 figure. 8 tables. 10 references.

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Nonvariceal Gastrointestinal Tract Bleeding. IN: Alexander, J.A. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 159-174.

This chapter on nonvariceal gastrointestinal (GI) tract bleeding is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The first section reviews upper GI bleeding, which constitutes 75 to 80 percent of all cases of acute GI bleeding. Peptic ulcers are the most common source of upper GI bleeding; other major causes are gastric erosions, bleeding varices, and Mallory-Weiss tears. Most cases of acute bleeding involve the use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). This section discusses the initial approach to patients with upper GI bleeding, prognostic factors, diagnosis, peptic ulcers, Mallory-Weiss tears, portal hypertensive gastropathy, aortoenteric fistula, hematobilia and hemosuccus pancreaticus, neoplasms, and vascular anomalies. The remainder of the chapter considers nonupper gastrointestinal (non-UGI) bleeding, covering diverticular bleeding, vascular ectasia, neoplasm, ischemic colitis, Meckel’s diverticulum, inflammatory bowel disease, benign rectoanal disease, infection, and NSAID enteropathy and colopathy. Patients who are being evaluated because of positive findings on fecal occult blood testing require colonic imaging for diagnosis. 16 references.

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Urinary Stone Disease. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 246-277.

This lengthy chapter about urinary stone disease is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The author notes that urinary stones are common, yet their cause remains uncertain. The author begins with a discussion of the etiology, role of urinary ions, stone varieties, and symptoms and signs at the presentation of urinary tract stones. Symptoms can include pain, hematuria, infection, associated fever, nausea, and vomiting. The author reviews diagnostic approaches to urinary stones and outlines the treatment options, including conservative observation, dissolution agents, relief of obstruction, extracorporeal shock wave lithotripsy, ureteroscopic stone extraction, percutaneous nephrolithotomy, open stone surgery, pyelolithotomy, anatrophic nephrolithotomy, radial nephrotomy, and ureterolithotomy. The chapter includes a section on special situations, including renal transplantation, pregnancy, dysmorphia, obesity, medullary sponge kidney, renal tubular acidosis, associated tumors, pediatric patients, caliceal diverticula, and kidney malformations. Prevention strategies are also outlined, including metabolic evaluation and the use of oral medications. A brief review of bladder, urethral, and prepucial stones is given. The chapter is illustrated with numerous black-and-white drawings and photographs. The chapter concludes with an extensive list of references, categorized by topic. 24 figures. 110 references.

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Acute Lower Gastrointestinal Tract Bleeding. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 363-374.

This chapter about acute lower gastrointestinal (GI) bleeding is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors cover clinical classification, differential diagnosis, specific causes of lower GI tract bleeding, management of acute lower GI tract bleeding, and anticipated outcomes. They stress that severe acute lower GI tract bleeding is associated with unstable vital signs, rapidly developing anemia, and a possible need for transfusion. Types of GI bleeding include low-volume and high-volume hematochezia, melena, occult GI bleeding, and pseudobleeding. Specific causes of lower GI tract bleeding include diverticulosis, angiodysplasia and vascular ectasia, Dieulafoy lesions, colonic varices, Meckel’s diverticulum, postpolypectomy bleeding, colitis, ulcers, neoplasia, endometriosis, and aortoenteric fistula. The risk of mortality in acute lower GI bleeding increases with age, transfusion requirements, comorbid conditions, and the frequency of rebleeding. 2 tables. 44 references.

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Benign Prostatic Hyperplasia, Bladder Neck Obstruction, and Prostatitis. IN: Atlas of Urodynamics. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2007. pp 96-119.

The purpose of urodynamic testing is to measure and record various physiological variables while the patient is experiencing those symptoms which make up the presenting complaint. This chapter on benign prostatic hyperplasia (BPH), bladder neck obstruction, and prostatitis is from an atlas of urodynamics that provides a comprehensive, detailed look at the indications, technology, and use of urodynamics in modern urologic practice. The chapter begins with a section defining the terminology currently in use, then goes on to cover mechanical obstruction, smooth muscle obstruction, differential diagnosis, urodynamic evaluation, primary bladder neck obstruction, acquired voiding dysfunction, bladder diverticula, the neurogenic bladder and BPH, and chronic pelvic pain syndrome and prostatitis. The authors then present case illustrations, accompanied by figures and black-and-white photographs of actual urodynamic tests. The authors note that, even in patients with documented prostatic obstruction, factors other than the mechanical effects of prostatic bulk play an important role. These include detrusor muscle strength and tone, bladder wall compliance, smooth muscle function of the bladder neck and prostatic urethra, striated muscle function of the prostate-membranous urethra, and interstitial factors such as elastin and collagen type. 18 figures. 1 table. 15 references.

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Bladder Outlet Obstruction and Impaired Detrusor Contractility in Women. IN: Atlas of Urodynamics.2nd ed. Williston, VT: Blackwell Publishing Inc. 2007. pp 120-144.

The purpose of urodynamic testing is to measure and record various physiological variables while the patient is experiencing those symptoms which make up the presenting complaint. This chapter on bladder outlet obstruction and impaired detrusor contractility in women is from an atlas of urodynamics that provides a comprehensive, detailed look at the indications, technology, and use of urodynamics in modern urologic practice. The chapter begins with a section on etiology and diagnosis, then present cases illustrations, accompanied by figures and black-and-white photographs of actual urodynamic tests. The authors note that urethral obstruction can be caused by prior surgery, prolapse, stricture, primary bladder neck obstruction, detrusor external sphincter dyssynergia (DESD), acquired voiding dysfunction, or urethral diverticulum; the two most common causes of genital prolapse and complications after anti-incontinence operations. From a urodynamic standpoint, the diagnosis of impaired detrusor contractility is characterized by a low flow and low detrusor pressure. 21 figures. 2 tables. 27 references.

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