Incidence and Etiology of the Lower Gastrointestinal Tract Bleeding in the period from 2011 -2013

Cilj provedenog istraživanja bio je izdvojiti bolesnike koji su hospitalizirani zbog krvarenja iz probavne cijevi u razdoblju od siječnja 2011. god. do prosinca 2013. godine te istražiti koliko često se radi o etiološkim čimbenicima krvarenja iz donjih dijelova probavne cijevi. Analizirano je i kako često krvarenje iz gornje probavne cijevi imitira krvarenje iz njenih distalnih dijelova, te koje su dijagnostičke i intervencijske metode primjenjene kod pojedinih krvarenja, s osvrtom na njihovu učinkovitost, škodljivost i jednostavnost primjene. Ispitanici/metode/postupci: u Klinici za unutarnje bolesti KBC Split na Jedinici intenzivne skrbi s interventnom gastroenterologijom u razdoblju od siječnja 2011. do prosinca 2013. godine liječeno je 1116 bolesnika s krvarenjem iz GI sustava. Raspon godina života bio je od 18 do 80 godina, od čega 807 muškaraca i 309 žena čija je prosječna životna dob iznosila 67,15 godina. Podaci su prikupljani retrospektivno, u razdoblju od tri uzastopne godine i to 2011., 2012. i 2013.godina. Korištena dokumentacija se bio je Protokol prijama bolesnika u Jedinicu intenzivne skrbi s interventnom gastroenterologijom i Povijesti bolesti u Odjelu za gastronterologiju KBC Split iz kojih su korišteni podaci koji se odnose na : anamnezu, kliničku sliku, metode i postupke liječenja te otpusno pismo liječnika. Rezultati/zaključci: Nakon provedene kvantitativne analize dolazi se do zaključka da su pacijenti najčešće muškarci. Prijemna dijagnoza kod većine bolesnika je melena, dok je krvarenje najčešće lokalizirano u želucu. Za liječenje krvarenja koriste se ezofagogastroduodenoskopija(EGDS) i kolonoskopija kao metode, gdje je EGDS metoda koja se češće korištena metoda. Pacijenti su u prosjeku starosne dobi 67,15 godina s malom standardnom devijacijom iz čega se može zaključiti da je riječ o bolestima starije životne dobi. Otpusna dijagnoza kod osoba muškog spola u najvećem broju slučajeva je krvareći ulkus dvnesnika, dok je kod osoba ženskog spola najčešće riječ o krvarećem ulkusu želuca. Potvrđena je statistički značajna razlika između otpusnih dijagnoza među osobama muškog i ženskog spola. Potvrđena je i razlika među osnovnim/pridruženim bolestima s obzirom na spol. Dakle, među ispitanicima muškarci najčešće obolijevaju od ciroze jetre, dok žene najčešće obolijevaju od arterijske hipertenzije. Testiranjem broja dana hospitalizacije s obzirom na osnovnu/pridruženu bolest došlo se do zaključka da u prosjeku najviše vremena u bolnici provedu bolesnici s kroničnom bubrežnom insuficijencijom, dok najmanje vremena u bolnici u prosjeku provedu osobe sa srčanom dekompenzacijom. Kod svih vrsta osnovnih/pridruženih bolesti najčešće korištena metoda je ezofagogastroduodenoskopija (EDGS). Analizirajući točnost otpusne dijagnoze u odnosu na prijemnu dijagnozu dolazi se do zaključka da kod hematemeze kao prijamne dijagnoze najčešće se točno procjeni dijagnoza (točnost 98,85%), dok je najveći stupanj pogreške kod hematokezije kao prijemne dijagnoze gdje je točnost dijagnoze 81,20 %.The AIM/GOAL of the investigation was to separate (set appart ) the patients who were hospitalized because of the bleeding from the lower parts of digestive tube in the period from January 2011. to December 2013. , and to investigate the frequency of the apperance of etiology factors of the bleeding from the lower parts of digestive tube, and also to find if that is also a case profuse with bleeding from stomach and duodendum, or not. The patients examined / methods/ and procedures in the internal clinic for internal diseases in Clinic hospital Split in the intensive care unit with interventional gastroenterology in the period from January 2011. to December 2013. The number of patients cured here was 1116 patients with gastrointestinal bleeding. The age of the patients was from 18 to 80 years; 807 were male patients while 309 were female patients, and their approximate age was 67,15 years. The data were collected retrospectively in the period of three years; 2011.,2012. and 2013. The documents used in the investigation were; The Act of admission od patients to hospital, and The Act of admission of patients in the intensive care unit with interventional gastroenterology, and Patients records in the Gastroenterology Ward of the Clinical hospital in Split from which were used all the important data referring to; anamnesis, methods and procedures used in treatments, as well as the Letters of release. Results: After all the analysis done the conslusion was that the patients were mostly men (in the biggest frequency). The admission diagnose, with the majority of patients, was MELAENA, while the bleeding was frequently localized in the stomach. For treatments of bleeding were used gastroscopy and colonoscopy, as methods, while (EGDS) was the most usually used method. The released diagnoses with the male patients in the majority of cases was the bleeding ulcer from duodendum; while the released diagnoses with female patients in majority of cases was the bleeding ulcer from stomach. It was confirmed statistically important difference between the released diagnoses of the male and female patients. It was also confirmed the difference between primary and secondary (joined) diseases according to the gender (male and female patients) All in all according to this investigation men are more prone to cirrhosis of liver while women are more prone to arterial hypertension. According to the number of days spent in hospital and in regard with the primary / secondary/ disease the conclusion was that the patients suffering from chronic kidney failure spent the longest time in hospital; while patients suffering from heart failure spent the least time in hospital. The method used in treatment with all above mentioned diseases was (EDGS). After analysing the precision and accuracy of the released diagnoses in refference with the admission diagnoses the conclusion was that in the most cases the accuracy was in the biggest rate in the admission diagnose ( about 98,85%) while the greatest frequency of the mistakes are present at hemathochesia were the admission diagnose accuracy is about (81,20%)