- Balloon Tamponade of Gastrointestinal Bleeding
- Nasogastric Tube Placement
- Rectal Foreign Body Extraction
- Use of anoscope to visually inspect the anus, anal canal, and internal sphincter, primarily for the purpose of identifying rectal bleeding.
- Evaluation of anorectal symptoms (bleeding, pain, discharge, protrusions, foreign bodies)
- Imperforate anus, active bleeding. Relative contraindications included severe anal pain or recent surgery.
- Perineal skin/mucosa injury, infection, shearing of hemorrhoidal tissue.
*Deep Dive: How To Do Anoscopy (Merck Manual)
Balloon Tamponade for Gastrointestinal Bleeding
- 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
- Unstable patient with massive upper GI bleed
- Recent esophageal or gastric surgery
- Esophageal rupture, mucosal ulceration, aspiration
Nasogastric Tube Placement
- Placement of a tube via the nasogastric route to provide access to the stomach for therapeutic or diagnostic purposes.
- Gastric decompression, administration of medication, administration of radiographic contrast, bowel irrigation
- Recent nasal surgery, severe facial trauma
- Pulmonary placement, epistaxis, gagging/vomiting
- Insertion of a needle/catheter into the peritoneal cavity to drain ascitic fluid for diagnostic or therapeutic purposes.
- Acute onset of ascites, suspected bacterial peritonitis
- Acute abdomen requiring surgery, severe thrombocytopenia, active bleeding
- Hemorrhage, bladder/bowel perforation, vessel laceration, infection, ascites fluid leak
Rectal Foreign Body Extraction
- Process of removing rectal foreign bodies. Common objects include bottles, vibrators, vegetables, fruit, or balls. May also be caused by drug packing/stuffing
- Bedside removal indicated if object is less than 10 cm proximal to anal verge or palpable on digital rectal exam
- Perforation, peritonitis
- Local tissue trauma, tearing of rectal mucosa
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