Gastrointestinal

  • Anoscopy
  • Balloon Tamponade of Gastrointestinal Bleeding
  • Nasogastric Tube Placement
  • Paracentesis
  • Rectal Foreign Body Extraction

Anoscopy

  • Background
    • Use of anoscope to visually inspect the anus, anal canal, and internal sphincter, primarily for the purpose of identifying rectal bleeding. 
  • Indications
    • Evaluation of anorectal symptoms (bleeding, pain, discharge, protrusions, foreign bodies)
  • Contraindications
    • Imperforate anus, active bleeding. Relative contraindications included severe anal pain or recent surgery.
  • Complications:
    • Perineal skin/mucosa injury, infection, shearing of hemorrhoidal tissue.
Video Credit: The General Medicine

*Deep Dive: How To Do Anoscopy (Merck Manual)



Balloon Tamponade for Gastrointestinal Bleeding

  • Background
    • Placement over an orogastric tube with balloon tamponade capabilities designed for the management of esophageal or gastric bleeding. Specifically devices include the sengstaken-blakemore tube, minnesota tube, and linton-nachlas tube
  • Indications
    • Unstable patient with massive upper GI bleed
  • Contraindications
    • Recent esophageal or gastric surgery
  • Complications
    • Esophageal rupture, mucosal ulceration, aspiration
Video Credit: EM:RAP

*Deep Dive: Balloon Tamponade of Massive GI Bleeding (First 10 EM)



Nasogastric Tube Placement

  • Background
    • Placement of a tube via the nasogastric route to provide access to the stomach for therapeutic or diagnostic purposes. 
  • Indications
    • Gastric decompression, administration of medication, administration of radiographic contrast, bowel irrigation
  • Contraindications
    • Recent nasal surgery, severe facial trauma
  • Complications
    • Pulmonary placement, epistaxis, gagging/vomiting
Video Credit: Geeky Medics

*Deep Dive: Nasogastric Tube Placement (Internationl Emergency Medicine Education Project)



Paracentesis

  • Background
    • Insertion of a needle/catheter into the peritoneal cavity to drain ascitic fluid for diagnostic or therapeutic purposes.
  • Indications
    • Acute onset of ascites, suspected bacterial peritonitis
  • Contraindications
    • Acute abdomen requiring surgery, severe thrombocytopenia, active bleeding
  • Complications
    • Hemorrhage, bladder/bowel perforation, vessel laceration, infection, ascites fluid leak
Video Credit: EM:RAP

*Deep Dive: Pocket Full of Sunshine: Paracentesis in the ED (emDocs)



Rectal Foreign Body Extraction

  • Background
    • Process of removing rectal foreign bodies. Common objects include bottles, vibrators, vegetables, fruit, or balls. May also be caused by drug packing/stuffing
  • Indications
    • Bedside removal indicated if object is less than 10 cm proximal to anal verge or palpable on digital rectal exam
  • Contraindications
    • Perforation, peritonitis
  • Complications
    • Local tissue trauma, tearing of rectal mucosa
Video Credit: procedurettes

*Deep Dive: Rectal Foreign Bodies: Not always a Simple ED Diagnosis (emDocs)


Brandon Simpson, PA-S2
Latest posts by Brandon Simpson, PA-S2 (see all)