Classification of the stigmata of bleeding ulcers, including prevalence and risks of further bleeding;
A, clean base; B, flat spot; C, adherent clot; D, visible vessel; E, active bleeding.
#Diagnosis #Gastroenterology #UpperGI #Rebleeding #Gastric #Ulcers #Prevalence #Stigmata #EGD #Endoscopy
Forrest Classification of Upper GI Bleeding
Acute Hemorrhage
Ia - Active Spurting, Re-bleeding Risk 60-100%
Ib - Active Oozing, Re-bleeding Risk 50%
Signs of Recent Hemorrhage:
Ila - Non-Bleeding Visible Vessel, Re-bleeding Risk 40-50%
IIb - Adherent Clot, Re-bleeding Risk 20-30%
IIc - Flat Spot in Ulcer Base, Re-bleeding Risk 7-10%
Lesions without Active Bleeding
III Clean-Based Ulcer, Re-bleeding Risk: 3-5%
Dr. Enrik Aguila @enrrikke
#Forrest #Classification #Upper #GIBleed #UGIB #diagnosis #endoscopy #gastroenterology #egd
Gastroenterology Endoscopy Tools and Accessories - A Visual Catalog for Trainees and Young Gastroenterologists
Biopsy Forceps:
• BIOPSY FORCEPS - To obtain biopsy
Retrieval Devices:
• RAT TOOTH GRASPING FORCEP - For retrieval of foreign objects
• ALLIGATOR GRASPING FORCEP - For retrieval of foreign objects; with wider grasp
• 3-PRONG GRASPING FORCEP - For retrieval of large polyp or foreign objects
• RETRIEVAL NET - For retrieval of large polyp or foreign objects
Hemostatic Tools/Devices:
• HEMOCLIP - For mechanical hemostasis, closure of mucosal defects, marking or anchoring
• INJECTION NEEDLE - For sclerotherapy for hemostasis; also used for submucosal injection to lift lesion prior to EMR/ESD
• HEMOSTATIC FORCEPS - Targeted coagulation for hemostasis at the precise site of bleeding
• HEATER PROBE - For thermal coagulation via heated tip and pressure application
• BIPOLAR COAGULATION PROBE - Bipolar spiral tip provides coagulation at any angle
• ARGON PLASMA COAGULATION - Monopolar, noncontact probe which emits ionized argon gas for hemostasis
• SINGLE-USE LIGATION DEVICE - For polyp ligation prior to polypectomy; prevents post-polypectomy bleeding
• OVER-THE-SCOPE CLIP - Clipping device that provides a strong tissue grasp and compression
• HEMOSTATIC SPRAY - Inorganic powder administered endoscopically which promotes hemostasis
• BAND LIGATOR - For endoscopic ligation of esophageal varices and anorectal hemorrhoids
• SUTURING DEVICE - For correction of defects such as fistula, Gl bleeding, perforation or tears using sutures
• SENGSTAKEN BLAKEMORE TUBE - Device used for tamponade of bleeding esophageal varices (3 ports)
• MINNESOTA TUBE - Device used for tamponade of bleeding esophageal varices (4 ports to allow aspiration of both gastric and esophageal contents)
Polypectomy, EMR, ESD:
• POLYPECTOMY SNARE - For polyp removal via cold or hot resection
• ESD KNIFE - For lateral incision and submucosal dissection of large lesions
• DISTAL CAP - To improve visualization and maintain constant distance while resecting large surface areas
• MUCOSAL TATTOO - For marking and identifying lesions along the Gl tract
• LIFTING AGENT - Injected in the submucosal layer to lift lesions and create a plane for dissection prior to EMR/ESD
• POLYP TRAP - Tissue container for easier colonoscopy specimen retrieval
• ENDOCUFF - Device attached to distal end of colonoscope designed to maintain and maximize viewable mucosa
Stricture Management:
• ACHALASIA BALLOON - For dilation of esophageal strictures; specifically indicated for patients with achalasia
• ESOPHAGEAL BALLOON DILATOR - For dilation of esophageal strictures
• SAVARY GILLIARD DILATOR - For dilation of esophageal strictures
• ESOPHAGEAL/ DUODENAL/COLONIC STENT - To expand and open obstructed sections of the GI tract; often used for palliative treatment
ERCP Tools/Devices:
• PEG TUBE - For percutaneous endoscopic placement to provide enteral nutrition for patients requiring nutritional support
• OVERTUBE - Used to prevent aspiration or mucosal laceration in upper Gl endoscopy
• RADIOFREQUENCY ABLATION DEVICE - Attached to the end of an which delivers radiofrequency energy or heat to cause tissue death
• SPHINCTEROTOME - For cutting the papilla and to assist in cannulation
• GUIDEWIRE - Facilitates access to both biliary and pancreatic ducts, maintain cannulation, and allow passage of instruments in ERCP
• STONE EXTRACTION BALLOON - Facilitates stone extraction via sweeping of the biliary tract with an inflated balloon
• BILIARY BALLOON DILATOR - For biliary dilatation and sphincteroplasty
• STONE EXTRACTION BASKET - For retrieval of stones in the bile duct or pancreatic duct
• MECHANICAL LITHOTRIPTOR - For mechanical crushing of stones within the duct
• SOEHENDRA LITHOTRIPTOR - For mechanical crushing of stones in the bile duct when other methods of endoscopic removal have failed
• SOEHENDRA STENT RETRIEVER - Used for endoscopic removal of stents from the biliary and pancreatic ducts
• CYTOLOGY BRUSHES - For collection of biliary specimen and detection of malignant neoplasms within the duct
• BILIARY METALLIC STENTS - Flexible metallic tube to keep the bile duct open, which has been blocked or partially blocked
• BILIARY AND PANCREATIC PLASTIC STENTS - Flexible plastic tube to keep the bile duct open, which has been blocked or partially blocked
• METAL BALL TIP CANNULA - Used to aid in difficult cannulation of the ductal system
• CANNULA FOR ENTEROSCOPY-ASSISTED ERCP - Used for cannulating the papilla in enteroscopy-assisted ERCP
• CHOLANGIO-SCOPE - Enables direct visualization of the pancreatic and bile duct
EUS Accessories:
• EUS FNB DEVICE - Device used for EUS-guided fine needle biopsy of suspicious lesions
• EUS BALLOON - Used to provide dearer views in EUS procedures
GI Endoscopes:
• ESOPHAGO-GASTRO-DUODENOSCOPE - Diagnostic, therapeutic (single, double channel), ultra-thin
• ENTEROSCOPE - Diagnostic, therapeutic (single, double channel), ultra-thin, motorized spiral
• COLONOSCOPE - Diagnostic, therapeutic, pediatric, variable stiffness
• ENDOSCOPIC ULTRASOUND - Radial scanning, linear array
• DUODENOSCOPE - Side-viewing to visualize ampulla; elevator to move accessories
• CAPSULE ENDOSCOPY - Tiny wireless camera that takes pictures as it passes through the Gl tract
Dr. Enrik Aguila @enrrikke
#Gastroenterology #Endoscopy #Tools #colonoscopy #accessories #EGD #colonoscopy #devices #eus #ercp
Decubitus Ulcer Staging - Pressure Ulcer Stages help staff determine Degree of Harm to the patient.
Stage I:
• Intact skin with localized, non-blanchable erythema over a bony prominence.
• The area may be painful, firm or soft and warmer or cooler when compared to surrounding tissue.
• Darkly pigmented skin may not show visible blanching, however the colour of the Stage I ulcer will appear different than the colour of surrounding skin.
• Indicates the patient is at risk for further tissue damage if pressure is not relieved.
Stage II
• A partial thickness wound presenting as a shallow, open ulcer with a red/pink wound bed.
• May also present as an intact or open/ruptured serum-filled or serosanguinous-filled blister.
• Slough may be present but does not obscure the depth of tissue loss.
Stage III
• A full thickness wound.
• Subcutaneous tissue may be visible but bone, tendon and muscle are not exposed.
• May include undermining or sinus tracks.
• Slough or eschar may be present but does not obscure the depth of tissue loss.
Stage IV
• A full thickness wound with exposed bone, tendon or muscle.
• Often includes undermining and/or sinus tracks.
• Slough or eschar may be present on some parts of the wound bed but does not obscure the depth of tissue loss.
#Diagnosis #Staging #Sacral #Decubitus #Pressure #Ulcers #Stages #III #IV #StageIII #Nursing
** GrepMed Recommended Text: Fitzpatrick's Color Atlas of Clinical Dermatology - https://amzn.to/2AyuB3T
