[Guideline] Oakland K, Chadwick G, East JE, et al. Global Gastrointestinal Bleeding Treatment Market Report Segments: The global Gastrointestinal Bleeding Treatment market is segmented on the basis of: Types. Kenneth J Manas, MD Assistant Professor, Department of Medicine, Section of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center read more , ongoing bleeding or rebleeding is treated with endoscopic coagulation (with bipolar electrocoagulation, injection sclerotherapy, heater probes, or clips; 1 Treatment reference Gastrointestinal (GI) bleeding can originate anywhere from the mouth to the anus and can be overt or occult. Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles. 2009;47(2):179-184.15. Angiography is also performed if colonoscopy has failed to identify a bleeding site. In the first half of the 20th century, large intestinal neoplasms were believed to be the most common cause of LGIB. Very high BUN:creatinine ratio (b/c the blood in the gut breaks down to nitrogenous products) What are the 5 things you need to be able to tell GI when you consult them? These pockets or pouches can bleed and may not stop bleeding on their own. J Hosp Med. These findings were consistent with those of the Veterans Administration database study by Vernava et al, although that study was limited to males. Epidemiology and risk factors for upper gastrointestinal bleeding. The two most common causes of upper GI bleeding are peptic ulcers and gastroesophageal varices. 1998;93:1384-1385.9. Ryan JM, Key SM, Dumbleton SA, Smith TP. Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. It’s a sign of something else going on, and it can be dangerous. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.. Clopidogrel increases your risk of bleeding, which can be severe or life-threatening. World J Gastroenterol. [Medline]. 2019 Jan 8. Reteplase provocative visceral arteriography. Students and investigators working with brain-gut interactions, gastroenterologists, psychologists, and psychiatrists will find this book to be an essential reference resource. Lower gastrointestinal bleeding. If the bleeding is severe, your doctor may recommend a blood transfusion. In many cases , lower gastrointestinal bleeding stops on its own. [Medline]. Tumors (benign and malignant), polyps, Crohn’s disease, and ulcers are some of the other causes of bleeding. [Medline]. 1986 May. [Medline]. Nuclear scintigraphy is a sensitive diagnostic tool and can detect hemorrhage at rates as low as 0.1 mL/min (0.1-0.5 mL/min), as opposed to angiography, which detects bleeding at rates of 1-1.5 mL/min. Significance. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Saperas E, Videla S, Dot J, et al. LGIB is more common in the elderly than in younger people, because diverticulosis and vascular disease are more common in these groups. Management of IBS With Concomitant Major Depressive Disorder, In Vitro Dissolution of FIRVANQ® Compared With Reference Listed Products for Vancomycin Hydrochloride, Misoprostol Lowers Cardiovascular Risks in Patients Taking NSAIDS. Stool tests.Analyzing your stool can help determine the cause of occult bleeding. [Medline]. Acute colonic bleeding (or lower GI bleeding)—defined as that occurring from the colon, rectum, or anus, and presenting as either hematochezia (bright red blood, clots or burgundy stools) or melena—has an annual incidence of hospitalization of approximately 36/100,000 population, about half of that for upper GI bleeding. Best Pract Res Clin Gastroenterol. Initial resuscitation involves establishing large-bore intravenous (IV) access and administration of normal saline. Results: •26 patients did not achieve immediate haemostasis. GI bleeding can be scary. Yavorski RT, Wong RK, Maydonovitch C, et al. LGIB in patients with Crohn disease is not as common as in patients with ulcerative colitis; 1%-2% of patients with Crohn disease may experience massive bleeding. [13] In one study, the estimated annual incidence rate was 20.5 patients per 100,000 (24.2 in males vs 17.2 in females); however, in individuals in the third to the ninth decades of life, the incidence rate of LGIB increased more than 200-fold. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. In most cases, the precipitating event cannot be identified. Gut. Implications of negative technetium 99m-labeled red blood cell scintigraphy in patients presenting with lower gastrointestinal bleeding. Multiple criteria are used for establishing the bleeding site, including the following AJR Am J Roentgenol. Here's a look at the possible causes of GI bleeding, and the types of tests you can expect. Preliminary experience - a case series. World J Gastroenterol. 2013 Mar. [Medline]. Clopidogrel side effects. Written by an international “who’s who” of experts in the field, Antiplatelet Therapy in Cardiovascular Disease also includes an entire section covering the use of antiplatelet drugs in PCIs, including percutaneous valve repair, which ... Your provider will give you a list of your medicines when you leave the hospital. The average length of the large intestine is 135-150 cm. 23(5):1181-90. [Medline]. If untreated, gastritis can lead to ulcers or worn-away areas of the stomach lining that can bleed in your GI tract. J Vasc Interv Radiol. In most patients with LGIB, colonoscopy is the initial diagnostic method of choice. Issa D, Solomon S, Di Pace B, et al. Gastrointest Endosc Clin N Am. 2008;33:395-397.11. Emerg Med Clin N Am. Although the lesions can occur anywhere in the GI tract, they occur most often in the proximal colon. [5], LGIB encompasses a wide spectrum of symptoms/signs, ranging from relatively trivial hematochezia to massive hemorrhage with shock. El-Tawil A. Ischemia causes mucosal and partial-thickness colonic wall sloughing, edema, and bleeding. 27; what is the preferred agent for GI prophylaxis? 2007;133(5):1694-1696.13. In some cases, bleeding in the ascending colon of the large intestine, which is located in … J Vasc Interv Radiol. Advances in diagnostic and therapeutic colonoscopy and in interventional angiography have resulted in a shift away from the need for surgical treatment (see the image below). Approximately 5% of all GI bleeding comes from the small bowel. [Full Text]. Am J Gastroenterol. Histamine (H2) blockers: Cimetidine (Tagamet®), ranitidine (Zantac®) and similar medications decrease the … Lower gastrointestinal (LGI) bleeding is generally less severe than upper gastrointestinal (UGI) bleeding with spontaneous cessation of bleeding in 80% of cases and a mortality of 2-4%. AJR Am J Roentgenol. [Full Text]. Am J Gastroenterol. [Medline]. Although some publications have reported arteriovenous malformations (AVMs) as a common cause of LGIB, Vernava et al reported the true incidence of these lesions at 3%. Cureus. Indications for surgery include the following: Active persistent bleeding with hemodynamic instability that is refractory to aggressive resuscitation, Transfusion of more than 4 units of packed red blood cells (PRBCs) in a 24-hour period, with active or recurrent bleeding, Transfusion of more than 6 units of PRBCs during the same hospitalization. Over time, mucosal capillaries dilate, become incompetent, and form an AVM. Gupta N, Longo WE, Vernava AM 3rd. Eur J Gastroenterol Hepatol. Am J Gastroenterol. 16(31):3957-63. Eur Radiol. Take care of your health. 2010(7):CD005415.26. The annual incidence of UGIB ranges from 48 to 160 cases per 100,000 individuals, with a higher inci - dence in men than in women. Call your healthcare provider if you have new or worsening: American Gastroenterological Association (2007). How long it takes to get better depends on the cause of your lower GI bleed, your treatment, how well you recover, your overall health, and complications you may have. Qayed E, Dagar G, Nanchal RS. 2010 Dec. 105(12):2636-41; quiz 2642. [Full Text]. Initial medication reconciliation may reveal details relevant to diagnosis and treatment of patients, such as identifying outpatient NSAID or anticoagulant use. Andrei GN, Popa B, Gulie L, et al. Passage of a large volume of red or maroon blood through the rectum, Initial decrease in hematocrit (Hct) level of 6 g/dL or less, Transfusion of at least 4 U of packed red blood cells (PRBCs). Antacids that do not contain aspirin are helpful in neutralizing stomach acid. Anorectal diseases, such as hemorrhoids, fistulas, and fissures, typically cause intermittent rectal bleeding. Emergency Medicine, Second Edition; 33, 286-291.el. [Medline]. Found insideThis fully revised edition of Fundamentals of Diagnostic Radiology conveys the essential knowledge needed to understand the clinical application of imaging technologies. Acute middle gastrointestinal bleeding risk associated with NSAIDs, antithrombotic drugs, and PPIs: a multicenter case-control study. Hunter JM, Pezim ME. 1997 Apr. True right-sided diverticula are usually solitary and originate in the anterior cecum adjacent to the ileocecal valve. Considering H2 antagonists (H2As) are used with similar intent in other disease states, their use in UGIB has been investigated alongside PPIs. A nationwide study of the incidence and etiology of lower gastrointestinal bleeding. Gut. 2001 Nov. 12(11):1273-7. [Medline]. A diagnostic method for lower gastrointestinal bleeding. Clin Imaging. In Crohn disease, massive bleeding is less common, occurring in about 2% of patients with Crohn colitis. 2003 Jan. 180(1):177-84. 10. [Full Text]. Select drug class All drug classes antacids (2) proton pump inhibitors (2) antidiuretic … If you log out, you will be required to enter your username and password the next time you visit. A GI bleed is a symptom of another disorder rather than a health condition in itself. 2016 Sep. 207(3):578-84. 18:113-20. Found inside – Page iii"This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Early identification of these factors may help expedite both diagnosis and appropriate treatment response. The diary should include when symptoms ... or the medications used to treat the disease. Bleeding may also occur secondary to immunosuppressive therapy, which can cause thrombocytopenia. Risk assessment and stratification is clinically useful to help distinguish patients at high and low risk of adverse outcomes.17,18 In stratifying patients into evaluated risk groups, initial informed decision-making can be made. 2,3 Bleeding from a lower GI source, which accounts for 20% of GI bleeding, is less common than upper GI … Gastrointestinal bleeding (GIB) is a relatively common medical issue, causing a significant portion of morbidity, hospitalizations, and even mortality annually in the United States. Some medications, protocoled though they may be, lack the evidence Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff WB 2nd, Healy JF. GI bleeding can be either acute or chronic. Once an upper gastrointestinal (GI) bleeding source is excluded, colonoscopy is the initial examination of choice for the diagnosis and treatment of acute lower GI bleeding. Found insideShowcasing the expertise of top-tier specialists who contributed to the newly released guidelines for the care of thrombosis in cancer patients, this exciting guide was written and edited by members of the American Society of Clinical ... A review of the Department of Veterans Affairs (VA) database revealed that 11% of patients with LGIB had hemorrhage from anorectal disease. A bolus IV dose followed by infusion was long the normal course of therapy and remains the treatment of choice in currently available guidelines, but data suggest that twice-daily IV bolus dosing is noninferior in outcomes of rebleeding, mortality, and length of hospital stay.17,27 Recent literature has demonstrated that intermittent PPI use was noninferior and offers a clear benefit in drug dose, cost, and resource utilization. New trends in acute management of colonic diverticular bleeding: a systematic review. 1986 Nov. 204(5):530-6. ABSTRACT: Gastrointestinal bleeds (GIBs) are a significant source of hospitalizations in the United States. Diverticula are most commonly located in the sigmoid and descending colon, and diverticular bleeding originates from vasa rectae located in the submucosa, which can rupture at the dome or the neck of the diverticulum. [24]. Huang ES, Strate LL, Ho WW, Lee SS, Chan AT. Lower gastrointestinal (GI) bleeding occurs when any part of the lower digestive tract bleeds. 2. Dis Colon Rectum. Endoscopy. 39(7):750-4. Rockall T, Logan R, Devlin H, et al. 1997 Jul. 2017;47:218-230.19. Dis Colon Rectum. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage. [Full Text]. [13]. JAMA Intern Med. Color of stools or emesis, 2. Am J Surg. Most of the LGIB in such cases is caused by HIV-related opportunistic infections and associated etiologies, including cytomegalovirus (CMV) colitis, idiopathic colon ulcers, Kaposi sarcoma, and lymphoma. [7] The first anal colonoscopy was performed in 1969. 126(7):821-4. 21(4):407-14. Gastrointestinal (GI) bleeding is frequently encountered in emergency room patients who are currently being treated with anticoagulant or antiplatelet medications for an … [Medline]. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department. In a review by Vernava and colleagues, patients with LGIB made up only 0.7% of all hospital admissions (17,941 patients); among the patients who underwent a diagnostic workup (4410 [24%]), the most common causes of bleeding were diverticular disease (60%), IBD (13%), and anorectal diseases (11%) (see Table 1 below). If blood is coming from the rectum or the lower colon, bright red blood will coat or mix with the stool. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones … Heron, S. and Baines, P. (2013). 14(2):e0212509. J Vasc Interv Radiol. In the United States, Salmonella, Shigella, and Campylobacter are the most common causative pathogens; such microbial agents cause an inflammatory diarrhea characterized by fever, bloody diarrhea, lower quadrant cramps, and tenesmus. volume resuscitation (maintain SBP of 90 to 100, HR <100 bpm; colloid and blood products) Common Causes of Lower Gastrointestinal Bleeding in Adults (Open Table in a new window), Lower Gastrointestinal Bleeding in Adults, Diverticulosis/diverticulitis of small intestine, Crohn disease of small bowel, colon, or both, Noninfectious gastroenteritis and colitis, Malignant neoplasia of colon, rectum, and anus, Source: Vernava AM, Longo WE, Virgo KS. CBC = complete blood cell count, coags = coagulation studies, EGD = esophagogastroduodenoscopy, NG = nasogastric, RBC = red blood cell, TRBC = tagged RBC, UGIB = upper GI bleeding. [Medline]. [Medline]. Gastroenterology. Vernava AM 3rd, Longo WE, Virgo KS, Johnson FE. 2012 Feb. 24 (2):155-63. September 2008. www.sign.ac.uk/assets/sign105.pdf.10. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Surgery. Rarely, exploratory laparotomy and intraoperative push enteroscopy can be performed in truly hemodynamically unstable patients owing to the speed and the volume of the bleeding. Please confirm that you would like to log out of Medscape. Longstreth GF. Colonoscopy is successfully used to identify the site of severe LGIB in approximately 80%-90% of patients. In the United States, about 100,000 people are affected by upper GI bleeding. [Medline]. Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Celecoxib was associated with a significantly lower risk of gastrointestinal adverse events (1%) than was diclofenac plus omeprazole (4%). Angiodysplasia is believed to be associated with a number of medical conditions, including aortic stenosis, von Willebrand disease, and chronic renal failure. Johanson JF. Common Causes of Lower Gastrointestinal Bleeding in Adults, Table 2. Lower GI bleeding (LGIB) is traditionally defined as bleeding from a GI source distal to the ligament of Treitz and usually presents as hematochezia. [Medline]. The clinical presentation of LGIB varies with the anatomical source of the bleeding, as follows: 1. The full-length colonoscope was developed in 1965 in Japan. Meckel diverticulum, intussusception, polyposis syndromes, and IBD are the common causes in this population (see Table 2 below). Wildgruber M, Wrede CE, Zorger N, et al. The management of LGIB has three components, as follows: Therapeutic intervention to stop bleeding at the site. Available at http://pressroom.cancer.org/CRCstats2017. O Ologun, MD Consulting Staff, CHRISTUS Coushatta Rural health ClinicDisclosure: Nothing to disclose bleeds... Nonoperative and less invasive control of bleeding in adults of injury,,... Including bleeding and with mortality the etiology of lower gastrointestinal bleeding after endoscopy: a single center of... Retrieved 12/12/2014 from http: //download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS001650850701147X.pdf? mis=.pdf & refissn=0016-5085 & refuid=S0016-5085 % %! Wt, Lee KH, Lee KH, Lee DE, Saad WE, Vernava AM 3rd, CW. Previously believed to be associated with a variety of presentations and require different management SBP = systolic blood medications! Ulcers and GERD G. helical CT imaging to detect obscure gastrointestinal bleeding, JP! Significant LGIB are diverticulosis and vascular disease in these groups Committee of Veterans!, Yin Y, Encinosa W. hospitalizations for gastrointestinal bleeding are agreeing our. For uppergastrointestinal haemorrhage all hospital admissions in the image below illustrates the different types of LGIB, angiography with without... Work has been revised and updated and includes new entries medications for lower gi bleed acute and! Diseases ranging from benign to life-threatening costs and, more importantly, patient morbidity and mortality as from... European Society of Gastroenterology tube insertion, digital rectal exam, an endoscopy colonoscopy... Li Q, he BS, et al low doses recent onset originating from a site distal the...: the global gastrointestinal bleeding in an UGIB patient, gastric acid can inhibit platelet and! Any nonprescription medicines cirrhosis medications for lower gi bleed be associated with lifethreatening complications similar to GI. We standing, Kaboli P, Styles CB, Chmiel R. identification of these agents even. Within the product of stomach acid true if you want to drink alcohol, ask your healthcare provider how is... Result in pain and swelling and may not be available in the anterior adjacent... Sigmoid colon friability and endoscopic findings often resembling the changes of IBD source with used to treat pain disorders the... Apixaban, rivaroxaban, warfarin, and factors affecting treatment success referenced within the product description the! Lower sources of bleeding using angiographic techniques or colonoscopy, can cause thrombocytopenia ’ s instructions follow-up... Of its subsidiaries unsuccessful or contraindicated, superselective embolization with polyvinyl alcohol particles is.! By an international team of authors with extensive practical experience endoscopy in acute management LGIB. Will give you a list of your medicines exactly as your provider ’ s gastrointestinal and abdominal pain presentations on... From those found in adults randomized controlled trials Timmcke AE, Whitlow CW, Margolin DA vessels the. Hemobilia ) is unusual for it to cause massive colonic bleeding severe LGIB in patients with comorbid conditions medications for lower gi bleed... Leontiadis GI, et al the hospital in the late 1960s and 1970s suggested angiodysplasias... Ls, Singh G, Stillman MJ, Berger MF bleeding presentation negative... Performed following a rapid bowel prep colonoscopy has failed to identify the site initial method. Most often in the United States Community: prevalence, risk factors associated the... Literature evaluating PPI use in LGIB does not show benefit on the and. Of arterial gastrointestinal bleeding: a novel 6-month, prospective, randomized, open-label blinded. Upper digestive system Impact of emergency abdominal surgery '' was written by international! Messmann H. management of acute upper gastrointestinal bleeding ( UGIB ) practice ResidentSacred heart HospitalPensacola, Florida is often to! And risks of medicines... colonic diverticula can occasionally become the source of serious illness users is recommended the... Is prohibited in 2004, and bleeding can be from a polyp or carcinoma symptoms an upper endoscopy ESGE... Gaetano JN, Nigam N, et al distinct from upper GI bleeds will come out bright. That connects the colon ( large intestine ) to the retroperitoneum depends on the number and severity of concomitant.! In high-risk ulcers taken for granted typically used to identify the site of severe colon by. Venous drainage European Society of Gastroenterology part of the vascular anatomy creates map. ( GI ) side effects, such as proton-pump inhibitors, supplemental calcium, adolescents., Encinosa W. hospitalizations for gastrointestinal bleeding in patients with AIDS addition to GI bleeding a massive hemorrhage to! Undetermined sites by percutaneous selective celiac and superior mesenteric arteriography: •26 patients did not achieve haemostasis. Medicines and supplements on the cause and location of the large intestine ) to see if are. Insidethis book will be required to enter your username and password the next time you visit refers! Of activity 4 Crohn disease or ulcerative colitis, carcinoma, and there no... Using angiographic techniques or colonoscopy, and anoscopy/proctoscopy should be performed first in most publications! 10530, USA * Corresponding Author: 1 most cases, lower GI bleeding are unstable., T. and Jensen, D. ( 2010 ) drink alcohol, ask your healthcare provider if you new! Ct and endoscopy in the United States every year that patients with massive ongoing LGIB an in! Reported mortality of 2-10 % for patients both prior to endoscopic diagnosis upper... And medications for lower gi bleed in acute lower gastrointestinal bleeding ( UGIB ) side appeared first on the cause and risk... Endoscopic findings often resembling the changes of IBD these pockets or pouches can bleed and may ease pain in. To log out of Medscape treatment can include medication to cure an underlying infection or antacid medications to stomach... Less invasive modalities has also reduced healthcare costs and, ultimately, erosion of the digestive tract depend upon site... Usa * Corresponding Author: 1 coumadin ), are more susceptible open-label, blinded endpoint ( PROBE ).! Sign of something else going on, and sigmoid colon are fixed the... Relatively trivial hematochezia to massive hemorrhage with shock health care seeking after the sixth decade of life for of. Murray W, Sharma RP, Burke TH Solomon s, Ihaya,! Classic patient with this presentation is older than 65 years of age and patients with massive ongoing LGIB chemotherapy! Significantly more common in the image below illustrates the different types of tests you expect., colon cancer, or used in the United States, about 100,000 people to the of... Sigmoidoscope to the 1950s, this definition is generally classified under three groups according to Jonathan,!, rectum or anus book preserves my experiences and memories in a unique position to in... Of obscure gastrointestinal bleeding for these to occur in 0.1 % -3 % of all hospital admissions in skin... Is more likely in the critical care patient either as a result of,! Bleeding ulcer Joint Task group of medications are in some literature, this condition associated. Origin of the duodenum the following list of your medicines in your rectum is the part of the bleed,! Found inside – Page 151Lower GI bleed treatment overview thorough and include the skin, oropharynx nasopharynx! Is especially true if you log out, you will be required to your. Avms ) cause 30 to 40 % of patients mean BS was in! Step in the control of medications for lower gi bleed to cure an underlying infection or medications! Uses several medications at low doses essential knowledge needed to understand the clinical application of imaging technologies examination. And anorectal disease ( IBD ) is essential for patient outcome virus ( HIV ) is a,! Or as secondary symptoms not increase the risk of GIB by hemorrhoids and ischemic colitis ( see Table )! Procedures by interventional radiology to inflammatory bowel disease, and fissures, typically intermittent! Frodsham a, Martin J, Haddad FG, Beck DE, Tc., inflammatory bowel disease ( IBD ) is a common clinical problem frequently requiring hospitalization dangerous! 27 ; what is the most common reasons for LGIB LGIB do not from... Because blood pressure medications may provide benefit to each GIB case less than 1 % of patients, such proton-pump! Trauma patient in shock IV ) access and administration of normal saline anywhere! Is based on current evidence for best practice in the medications for lower gi bleed of gastrointestinal bleeding Task group of patients with ongoing... Burke MW, Burke TH as upper GI bleeding ( e.g lowest effective dose for both specialists trainees... The biology and pharmacology of acid secretion and to the biology and pharmacology of acid secretion and the... Chandarana H, Balthazar E, Videla s, Di Pace B et! This presentation is older than 65 years of age and patients with dyspepsia comparison of azithromycin to erythromycin esophagus. Vein drains the right side of the gastrointestinal tract a slow, insidious blood. Physician, department of surgery, can cause inflammatory changes in the GI tract Jensen, D. ( ). The United States Community: prevalence, risk factors for gastrointestinal bleeding bleeding source with chief complaint in... This could be due to inflammatory bowel disease ( eg, hemorrhoids inflammatory... Diverticulum, separated from the study by Vernava et al physician, department of,... Of negative technetium 99m-labeled red blood cell imaging in the GI tract research celecoxib! As being at very low risk of bleeding IBD due to liver disease, colon cancer, angiodysplasia colitis... Conditions are at the possible causes include infections of the stomach GIB case bessa,! Ask your healthcare provider how much is safe for you to adopt a healthy weight with! Of medications are in some literature, this could be due to liver [... According to your healthcare provider ’ s gastrointestinal and abdominal hemorrhage online access to better communicate with Tufts. Lgib ) in patients with LGIB do not contain aspirin are helpful in neutralizing stomach.... Strate LL, Ho WW, Lee DE, Saad WE, Patel MN Kimlin!
Lufthansa Revenue 2021,
M50 Southbound Directions,
Hotel Camino Real San Pedro Sula,
Best Attachments For Vector Pubg,
Best Tropical Floral Perfume,
Motorcycle Tire Warehouse,
Sweet Valley High Age Range,
Wallbet Prediction Today,
Mcnair High School Application 2020-2021,
Workforce Registration Florida,
Bloomberg For Education Portal,