Gastrointestinal

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

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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.

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

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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

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

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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

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

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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

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

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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

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

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