Podcasts about gi bleeds

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago. The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolics https://www.bostonscientific.com/obsidio --- SHOW NOTES 00:00 - Introduction 03:29 - Discussion on Upper GI Bleeds 06:35 - Pre-Procedure Imaging for Upper GI Bleeds 11:16 - Procedure Walkthrough for Upper GI Embolization 19:51 - Understanding Mesenteric Anatomy 22:50 - Embolization Devices: Coils and More 25:31 - Exploring Obsidio: A New Embolic 32:55 - Post-Procedure Care 34:17 - Case Discussions and Final Thoughts --- RESOURCES Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed: https://thegestgroup.com/webinar-featuring-obsidio/ BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler: https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization Obsidio - Conformable Embolic: https://www.bostonscientific.com/obsidio

CME credits: 1.50 Valid until: 11-08-2024 Claim your CME credit at https://reachmd.com/programs/cme/meaningfulness-of-isth-chart-audit-of-in-hospital-mortality-for-gi-bleeds/14738/ The introduction and assessment of real-world data (RWD) associated with FXa inhibitor-related bleeds is of critical importance in treatment-emergent situations, as there has been limited information disseminated to date within the relatively complex clinical landscape. This program focuses on the role of reversal agents in the presence of life-threatening bleeds while on an anticoagulant. It covers the most recent key RWD published relative to the use of reversal or repletion strategies in anticoagulated patients.

In the April episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss illnesses of bioterrorism as well as upper GI bleeds. As always, you'll hear about the hot topics covered in CDEM's regular features, including posterior auricular mass in Clinical Pediatrics, flexor tenosynovitis of the thumb in Critical Cases in Orthopedics and Trauma, dorsal penile nerve block in The Critical Procedure, buprenorphine for opioid withdrawal in the LLSA Literature Review, and chest trauma in older patients in The Critical Image.

Join Dr. Mike Wallace and Dan McCollum as they discuss the management of patients with gastrointestinal hemorrhage. What is the initial management of these patients? Who requires blood transfusions? Which patients require admission to the floor or the ICU? Pearls and pitfalls in the management of these challenging patients are discussed.  Enjoy!

CME credits: 1.50 Valid until: 31-03-2024 Claim your CME credit at https://reachmd.com/programs/cme/emergency-medicine-perspectives-targeted-vs-nonspecific-approaches-to-anticoagulation-reversal-in-real-world-analyses-for-ich-or-gi-bleeds/14859/ Patients presenting to the hospital with severe bleeding and underlying treatment with Factor Xa (FXa) or Factor IIa inhibitors represent an enormous challenge to providers and clinicians since the approvals of apixaban, edoxaban, rivaroxaban, and dabigatran within the United States. Intracranial bleeding, intra-abdominal or thoracic trauma, gastrointestinal bleeding, and bleeding from any non-compressible source represent true life-threatening emergencies. Treatment of severe bleeding in patients receiving Factor Xa and Factor IIa inhibitors currently involves using non-specific therapy such as blood factor replacement - packed red blood cells (pRBCs), fresh frozen plasma, and platelets. With the development and approval of reversal agents, treatment of severe bleeding can now be specifically directed at the source of the coagulopathy combined with appropriate blood factor replacement. Nationally recognized guidelines have provided clear direction on how best to manage these types of major bleeding events. While published guidelines are an important resource in helping direct how to appropriately intervene, the inherent clinical and system challenge is as follows: How do I justify and juxtapose the clinical rationale for using a reversal agent with the inherent cost associated with it with a lack of comparative head-to-head studies? Our assessment of learners suggests that knowledge and …

Host: Jennifer Caudle, DO Guest: Majed Refaai, MD While VKA-related GI bleeds are common, clinicians need to be aware of the severity of the bleed, especially in cases of hemodynamic instability. To get a better understanding of the impact of this severity, Dr. Majed Refaai from the University of Rochester Medical Center shares insights on these life-threatening bleeds.

Host: Jennifer Caudle, DO Guest: Majed Refaai, MD While VKA-related GI bleeds are common, clinicians need to be aware of the severity of the bleed, especially in cases of hemodynamic instability. To get a better understanding of the impact of this severity, Dr. Majed Refaai from the University of Rochester Medical Center shares insights on these life-threatening bleeds.

CME credits: 1.00 Valid until: 01-11-2023 Claim your CME credit at https://reachmd.com/programs/cme/case-study-life-threatening-gi-bleeds-and-anticoagulation-reversal-in-the-ed/14426/ tbd

CME credits: 1.00 Valid until: 01-11-2023 Claim your CME credit at https://reachmd.com/programs/cme/life-threatening-gi-bleeds-and-anticoagulation-reversal-in-the-ed/14425/ tbd

CME credits: 1.00 Valid until: 17-10-2023 Claim your CME credit at https://reachmd.com/programs/cme/life-threatening-gi-bleeds-and-anticoagulation-reversal-approaches-in-the-emergency-department/14815/ This program discusses the role of reversal agents in the presence of life-threatening bleeds while on an anticoagulant. It focuses on managing the anticoagulated patient with life-threatening intracranial bleeding, gastrointestinal bleeding, and post-traumatic bleeding in the Emergency Department. This enduring activity was originally presented as a satellite symposium which was held during the ACEP 2022 Scientific Assembly in San Francisco, CA.

Whether it is upper or lower, gastrointestinal hemorrhages can present in a variety of ways from a variety of sources. Bleeding esophageal varices, in particular, can be life-threatening. How do we manage these patients? When is it appropriate to establish an advanced airway? Are gastrointestinal tubes contraindicated even though the patient is vomiting? And what do we do when an esophageal tamponade device is indicated or already in place? Tune in to another podcast episode where we discuss GI bleeds. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/deed.en_US

It's that time of the week again, and we're back with another episode of Gastro News for you! This time, on Episode 4, we're thinking through a fairly common issue in gastroenterology, but one that it's important we all feel prepared for and confident in managing when we come across it – upper GI bleeds.To help us along the way we're joined today by Dr Monira Rahman, who is a Gastroenterology Consultant at Surrey and Sussex Healthcare Trust. Some of her main interests include inflammatory bowel disease and medical education, and she has really kindly given us some of her time to explain exactly what we need to remember when faced with someone experiencing an upper GI bleed.Have you been enjoying the series so far? If so, we'd love to hear from you! Get in touch with any questions, queries or suggestions for future episodes by finding us on Twitter @medregnews or dropping us an email at medregnews@gmail.com.Please keep spreading the word about the podcast amongst your friends and colleagues, and we look forward to seeing you for more Gastro News very soon!

In this episode, Davis and Will discuss GI bleed management. Although many of these patients are not truly critical care management, when they do fall into that category it can be complex, especially when trying to get these patients definitive care. They discuss everything from blood products, airway management, NG/OG tubes, to pharmocology management. Enjoy!

In this episode we discuss a recent paper published jointly in The American Journal of Gastroenterology and the Journal of the Canadian Association of Gastroenterology entitled American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period and co-authored by a Canada – United States team of experts.The interview with co-authors Dr Alan Barkun and Dr Jim Douketis covers the rationale for the new guidelines as well as the implications for clinicians. Dr Barkun is Professor of Medicine in the Division of Gastroenterology at McGill University and the McGill University Health Centre, Montréal, Canada. He is current holder of the DG Kinnear Chair in Gastroenterology at McGill University. Recipient of many national and international awards, Dr. Barkun has published over 400 peer-reviewed articles and abstracts and has given over 600 international presentations on emerging digestive endoscopic technologies, with an emphasis on methodological, clinical and cost-effectiveness trials of treatments for upper gastrointestinal bleeding (UGIB), bilio-pancreatic diseases and colorectal cancer screening. He is also the current President of the colorectal Cancer screening implementation committee for the province of Quebec. ANDDr. Douketis is Staff Physician in General Internal Medicine and Clinical Thromboembolism at St. Joseph's Healthcare Hamilton. He is a Professor of Medicine and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University. Dr Douketis is past-president of Thrombosis Canada.Dr. Douketis' research interests include perioperative antithrombotic therapy, prognosis of patients with venous thromboembolism, hormonal therapy and thrombosis, prevention of venous thrombosis in medical patients, and clinical practice guideline development.Dr. Douketis is a Fellow of the Canadian Academy of Health Science,  Associate Editor of McMaster Textbook of Internal Medicine, Editor-in-Chief of Canadian Journal of General Internal Medicine, Deputy Editor of Annals of Internal Medicine ACP Journal Club, and Associate Editor of Thrombosis and Haemostasis. He has over 350 peer-reviewed publications.Related Thrombosis Canada Resources:DOAC Bleeding Management Clinical Guide:  [LINK]DOAC Perioperative Management Clinical Guide: [LINK]Perioperative Anticoagulant Algorithm: [LINK]Follow us on Twitter: @thrombosiscanReference:Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Journal of the Canadian Association of Gastroenterology. 2022 Apr;5(2):100-1Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

GI Bleeds show up on essentially all the USMLE Step 2CK/3 exams. In this short podcast, I discuss an accurate approach to correctly answering these questions on the exam. Audio Download

Interventional Radiologist Donald Garbett and our host Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds, including radial vs. femoral approach and preferred embolics. --- CHECK OUT OUR SPONSOR Boston Scientific IOE https://www.bostonscientific.com/ioe --- SHOW NOTES In this episode, interventional radiologist Dr. Donald Garbett and our host Dr. Sabeen Dhand discuss their standard workups and procedural decision making for GI bleeds. The doctors start by describing the workup. Dr. Garbett says that the majority of his cases are referred from GI, either when GI cannot find the bleed or cannot access the bleed because of excessive bleeding into the GI lumen. Dr. Garbett often uses triple phase CT angiography. He emphasizes the importance of doing triple phase, in order to distinguish between arterial bleeds and varices, as this difference will guide further treatment decisions. In non-emergency situations, Dr. Garbett prefers transradial access. He discusses his use of various embolic agents such as glue and combination of both detachable and pushable coils. Dr. Dhand mentions newer embolics such as Onyx. He adds that he sometimes administers a low dose of glucagon to inhibit bowel movements. Finally, the doctors share various pearls of wisdom for GI embolization, such as the advantages of provocative angiogram, treatment decisions when a patient is crashing, and variceal indications for balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS). --- RESOURCES Ep. 118 BRTO vs. PARTO in Gastric Variceal Bleeding: https://www.backtable.com/shows/vi/podcasts/47/brto-vs-parto-in-gastric-variceal-bleeding YouTube Video: Embolization and Provocative Angiography in Lower GI Bleeds: https://youtu.be/0MESQkTG6hI

Massive upper GI bleeds can be intimidating and lethal. An expeditious, multidisciplinary approach is required to improve survival and optimize patient outcomes. Time Stamps:00:12 Welcome & Introduction01:55 Goals & Objectives02:29 Common Etiologies & Differential Diagnosis for UGIBs05:15 Initial Evaluation10:52 Initial Management15:38 Indications & Timing of Endoscopic and Non-Endoscopic Interventions18:19 Forrest Classification of Peptic Ulcers20:43 Indications & Timing of Surgical Interventions21:30 Surgical management of Bleeding Peptic Ulcers23:40 Take Home Points25:10 CTAConsider becoming a Patron of the Show!Support the show (https://www.patreon.com/traumaicurounds)

Dr. Rajiv Thavanathan sits down with Dr. Jim Yang to talk about some of the best high impact trials in the last year in Emergency Medicine. Which patients with a GI bleed need urgent endoscopy?  Secondly, which patients ACTUALLY need targeted temperature management after cardiac arrest.Check out the full show notes here.

Situation Situation Pantoprazole 80 mg in NS 100 mL drip is being used for GI Bleeds due to ulcers Problem: Evidence not being clear on Continue reading The post Episode 25: Pantoprazole Continuous infusion vs Intermittent Bolus Formulary Nugget by Oscar Santalo appeared first on The Pharm So Hard Podcast.

Date: September 16th, 2020 Guest Skeptics: Dr. Robert Goulden and Dr. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. Robert's academic interests include research and evidence-based medicine. Alongside his EM residency, he is doing a PhD in epidemiology. Audrey's academic interests include trauma and resuscitation. Outside of medicine, Audrey likes […]

Abby K. Hendricks, Pharm.D., (@HendricksPharmD) reviews strategies to mitigate the risk of gastrointestinal bleeds (GIB) with antithrombotics, shares literature assessing management of antithrombotic therapy after a bleeding event, and designs a treatment plan for appropriate re-initiation of anticoagulants and antiplatelets following GIB.For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter!You can also connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Drs. Pescatore and Raja talk about palliative care teams in the ED for COVID-19 patients, figuring out whether patients want a full code, and how you should stop using TXA for GI bleeds, even though Dr. Pescatore supported its use two years ago. Find the Lancet article they discuss at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30848-5/fulltext.

This week, we review the "HALT-IT" trial. Will you routinely give your patients TXA (tranexamic acid) in the setting of GI bleeds after reading this study? References: Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020; 395: 1927-36Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017; 389: 2105–16Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23–32

We’ve discussed TXA, both for trauma and for epistaxis, on the podcast previously. Medics often ask about TXA in the acute GI bleed patients who are in hemorrhagic shock...“What can it hurt? It’s worth a try, right?” While TXA may seem like a harmless hail Mary, on this episode, Dr. Patrick reviews the HALT-IT study and discusses why TXA for acute GI bleeds is likely harmful and probably dead in the water as a treatment option. REFERENCES: 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30848-5/fulltext

Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians.  Definitive therapy for acute GIB often includes endoscopy or surgery. However,... The post REBEL Cast Ep85: The HALT-IT Trial – TXA in Acute GI Bleeds appeared first on REBEL EM - Emergency Medicine Blog.

Patients with active GI bleeding are definitely high on my list of things that make me nervous. In many cases these patients can decompensate quickly, so careful monitoring and decisive action are key to keeping them safe. In this podcast episode, we’ll talk about the nursing care of patients with GI bleeds so that you can feel ready for anything. . Want to be the most organized student in your class? Get the planner made just for nursing students here: www.etsy.com/shop/straightanursing . Do you LOVE the PodQuizzes at the end of some of our episodes? Then you’ll LOVE our flashcard app (COMING SOON!). Get on the waitlist here and be the first to know when we launch: https://straightanursing.ck.page/82facc6b25

Tranexamic Acid (TXA) has gained a significant amount of attention over the last few years as multiple studies have shown it's utility in decreasing haemorrhage and associated mortality. It has become part of major trauma guidelines, post part haemorrhage protocols and many have adopted it to the management of traumatic brain injury. The findings have been very similar across a spectrum of haemorrhage disease processes and from this further interest in expanding TXA's application to pretty much anything that bleeds. Time from onset of the bleeding has been shown to be important, with it's effect decreasing from time of onset to its administration. Gastro-intestinal bleeding is a significant cause of morbidity and mortality. Previous meta-analyses have shown favourable outcomes for TXA in GI bleeds and many have already adopted TXA into this area of practice, although guidance from NICE does not yet recommend it. HALT-IT is a multi centre, international, randomised double blind controlled trial of near 12,000 patients that has just been published in the Lancet. The study was a huge piece of work and looks to definitively answer the question of whether we should be giving TXA to patients with life threatening GI bleeds. In this podcast we run through the ins and outs of the paper ad are lucky enough to speak to the lead author Ian Roberts about the findings, some of the intricacies of the trial and what the results mean for practice. Enjoy! Simon, Rob & James  

Don't bl-eed what you hear! In this Stat Medical Topics Episode we cover the following: Definition and causes (0:26) Presentation (5:02) Investigations (12:46) Acute and ongoing management (17:18) Summary and sign off (29:55)

In the first ever MINT podcast series, Hamish McDonald hosts the second GPA resus with special guest Romesh Rathnayake as the whole MINT crew discuss GI bleeds.

Dr Jonathan Hoare discusses the latest lower GI bleeding guidelines with Mr Phil Tozer in another corridor chat from St Mark's Frontiers 2019

In this video we talked about a my personal approach on GI Bleeds. Whether you’re a medstudent or nursing student, you’ll learn how to manage pulmonary embolism on this podcast. Be sure to check out medicalbasics.com for more educational resources! Prefer Video? Check out the youtube video: https://youtu.be/GST2-jOrb9s

This weeks’ episode is brought to you by McMaster medical student Tyler McKechnie. medical student at McMaster University. He will be discussing lower gastrointestinal bleeding. After listening to this podcast you should be able to: Explain the pathophysiology of lower GI bleeds Review the importance of correctly identifying lower GI bleeds Outline clinical presentation List the differential diagnosis Describe possible investigations Review treatment options

This week’s podcast is brought to you by McMaster medical student Tyler Mckechnie. This is one of two that will discuss the topic of gastrointestinal bleeding. In this podcast, we will address upper GI bleeds, while next podcast we will address lower GI bleeds. After listening to this podcast you should be able to: Describe the relevant pathophysiology Explain the importance of correctly identifying upper GI bleeds Review the clinical presentation List possible differential diagnosis Understand possible investigations and treatment options

Get our your cordis’ and coffee - today we get the full scope on GI Bleeds and Hemorrhagic Shock. Read more and see attributes at pulmcast.com

After a slight hiatus, Med On The Go is back! Dr. Oli is refreshed and excited to share more medical learning with you! This week we discuss the often very dramatic upper GI bleeding. It is such a big topic that we will have to revisit specific conditions at a later time; but for now, find out what exactly is upper GI bleeding, what are the causes, how to investigate it, and how to manage it. Happy learning! As always, notes are available at our website www.medongo.blogspot.ca and check out our Facebook page www.facebook.com/drolimedonthego for interesting articles, useful quizzes, and funny medical jokes. If you wish to support us, please visit www.patron.podbean.com/medonthego for more info.

Dr. Jordan Burlen presents Part Two of GI Bleeds by covering Lower GI Bleeds. Stay tuned for more Little Lectures! Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers©2016 LouisvilleLectures.org

Dr. Barkun will answer 15 questions from a trainee perspective on the management of Upper GI Bleeds. Learning Objective: By the end of this episode, you will have an evidence based understanding of how to optimally manage patients with Upper GI Bleeds in the context of patients with non-variceal upper gastrointestinal bleeding.

Dr. Jordan Burlen presents Part One of GI Bleeds by first covering Upper GI Bleeds. Stay tuned for his talk on Lower GI Bleeds! Behind the scenes at Louisville Lectures, we have been hard at work on a new series: "Little Lectures." Based on feedback from YOU, our loyal viewers, we are excited to present an under ten-minute video series created by residents for learners. These will focus on delivering just-in-time algorithms, practical clinical knowledge and board tips on high-yield topics. These lectures will be provided by the University of Louisville Internal Medicine residents. Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers©2016 LouisvilleLectures.org

Join the EMGuideWire team as they tackle the tough core concepts of how to manage the patients with simple and critical Upper Gastrointestinal Bleeds. Know what medicines are imperative to start and what ones may be discussed with your consultants.

Talks on esophageal emergencies, vomiting, upper GI bleeds, lower GI bleeds, constipation and everyone's favorite diarrhea

Dr. Michael Winters is an Associate Professor in both Emergency Medicine and Internal Medicine at the University of Maryland.  He is an internationally known speaker in the area of critical care specifically in the Emergency Department setting and an amazing clinician as well.  We were fortunate enough to have Dr. ...

50,000 people end up in hospital every year in the UK because of bleeding from the top end of the gut - an upper gastrointestinal bleed. Around 1 in 10 of them will die. Gastrointestinal or GI bleeds are often due to ulcers - a side effect of taking aspirin and other non-steroidal anti-inflammatory drugs like ibuprofen and diclofenac. The bleeding can occur in the gullet, stomach or the first part of the intestine, the duodenum. Other causes include cancers and liver disease. The location of the bleed can be pinpointed by using an endoscope - a camera to look inside the gut - and treatments include stopping the bleeding with clips, heat or injections of adrenalin. The National Institute for Health and Clinical Excellence hopes to change that with new guidelines on managing GI bleeds - guidelines which, as of last month, hospitals in England, Wales and Northern Ireland will be expected to follow. Scotland has had similar guidance in place for the last few years. David Patch is a Consultant Hepatologist at the Royal Free Hospital in London and has a special interest in this type of bleeding. He says that patients whose needs cannot be met at smaller hospitals should be transferred to specialist units where they can be treated promptly. Tariq Iqbal who's a consultant gastroenterologist at the University of Birmingham is evaluating a new kind of treatment called Hemospray. This is a powder that can sprayed over the bleeding area to stop or slow any bleeding by accelerating the natural clotting process. New research appears to show that standing at work for long periods in pregnancy can affect the unborn child. Research in the journal Occupational and Environmental Medicine, followed 4,680 mothers throughout their pregnancies. Some of the women had jobs where they were on their feet a lot - such as hairdressing, sales and working with toddlers. Women who stood for a long time had babies with smaller heads. It's thought that standing for long periods of time causes blood to "pool" in the legs, limiting the blood supply to the rest of the body including the uterus and therefore the developing foetus. The study also showed that working up to 36 weeks of pregnancy had no impact on birth weight, size or prematurity. Previous studies have shown that heavy lifting increased the risk of babies being born early - but this study showed no such link. Many people with pain and stiffness in the shoulder are told they have a frozen shoulder. But the label is often incorrect as a truly frozen shoulder means restricted movement in all directions, accompanied by pain. It's not known what causes it but it is commoner in people with diabetes. During the very painful initial phase it's best to rest the shoulder and use analgesia to help relieve the pain, especially at night time when it can be at its worst. TENS and acupuncture can help sometimes. The tissues in the shoulder "capsule" appear to be thickened and rubbery - and some relief can be gained from surgery, to let the shoulder move more freely. If left alone about half of patients still have discomfort after 7 years - so the common belief that it lasts 2 years is a myth. As the pain starts to recede physiotherapy can be helpful and if there is inflammation - eg with calcified tendonitis - then steroid injections can relieve pain. Producer: Paula McGrath.