| Abstract [eng] |
This Master’s thesis analyzes the treatment options and outcomes of acute intra-abdominal and gastrointestinal bleeding. This study is highly relevant as these pathologies remain among the most frequent life-threatening emergencies in medicine, characterized by an overall mortality rate of 2–10%, which can reach up to 36% within six weeks in cases of variceal bleeding. The aim of the work was to select and analyze scientific publications from 2021–2026 and to systematize modern diagnostic and treatment algorithms for these conditions. The research was conducted as a narrative literature review incorporating PRISMA-type search elements. The information search was performed in PubMed, Google Scholar, and Cochrane Library databases between November 2025 and May 2026. The final analysis included 32 scientific sources, encompassing systematic reviews, meta-analyses, and clinical trials involving adult populations. Analysis of risk assessment methods determined that the Glasgow-Blatchford score best predicts the need for intervention in upper gastrointestinal bleeding (UGIB), with an $AUC$ of 0.77–0.78. In the geriatric population, the shock index demonstrated exceptionally high discriminative power, with an $AUC$ reaching up to 0.988. For the diagnosis of lower gastrointestinal bleeding (LGIB), the Oakland score reliably identifies patients suitable for safe outpatient management, with an $AUC$ of 0.84–0.85. In the field of imaging, CT angiography achieves 85.2% sensitivity and 92.1% specificity, thereby ensuring accurate localization of the bleeding source. When evaluating modern treatment modalities, it was found that TC-325 hemostatic powder ensures 96–97% immediate hemostasis. The use of OTSC (over-the-scope) clips for large ulcers reduces the rebleeding rate to 10%, compared to 18% when applying standard measures. Even higher efficacy was observed using Doppler-guided endoscopy, where the rebleeding risk was only 3%, compared to 13% in the control group. In cases where endoscopic treatment is insufficient, transarterial embolization remains a highly successful alternative, characterized by a technical success rate of 98.7–100%. The final conclusions of the work confirm that modern bleeding management must be based on a structured algorithm where standardized risk scores guide the patient toward the correct diagnostic and therapeutic pathway. Minimally invasive methods, such as advanced endoscopy and transarterial embolization, are becoming priority strategies that increasingly replace traditional open surgery. |
