46 - Acute hemorrhage (LGIB)

Question 1

LGIB is bleeding originating distal to the ___

Answer 1

ligament of Treitz

Question 2

LGIB is __ common than UGIB, but with the same ___ rate (3% and raised with age)

Answer 2

less

mortality

Question 3

__% of LGIB originate from the __, the rest are from the ___

Answer 3

95
colon
small intestine

Question 4

The most common LGIB etiologies in adults are ___ and ___.

Answer 4

angiodysplasia

diverticular disease

Question 5

The most common LGIB etiology in children is___.

Answer 5

intussusception

Question 6

The most common LGIB etiology in adolescents is___.

Answer 6

Meckel’s

Question 7

LGIB is usually __ sever, ___ intermittent, and stops ___ when compared to UGIB

Answer 7

less
more
spontaneously

Question 8

LGIB initial treatment starts with ___ and stabilizing the patient, followed by ___ and ___ including __

Answer 8

resuscitation
history
physical examination
PR

Question 9

After initial treatment, LGIB patients will go through ___/___ to rule out anorectal bleeding (3)

Answer 9

anoscope
sigmoidoscopy
hemorrhoids
fissures
tumors

Question 10

In case of massive bleeding, we must insert __ tube tp rule out ___

Answer 10

NG

UGIB

Question 11

How will you treat an instable LGIB patient?

Answer 11

surgery

Question 12

What are the 3 courses of action when treating a stable LGIB patient?

Answer 12

colonoscopy
RBC scintigraphy
CTA

Question 13

____ disease is the most common reason for LGIB

Answer 13

diverticular

Question 14

Diverticular LGIB- __% of patients bleed, __% stop spontaneously, ___% will rebleed in the following 10 years

Answer 14

3-15
75
50

Question 15

Diverticular LGIB– usually from the __ of the diverticula, originating from the ____ penetrating the submucosa

Answer 15

neck

vasa recti

Question 16

Diverticular LGIB- ___ side is more common, but ___ side tends to bleed more

Answer 16

left

right

Question 17

Diagnosing diverticular LGIB is done with ___

Answer 17

colonoscopy

Question 18

What are the 3 ways to treat diverticular disease when performing colonoscopy?

Answer 18

injecting epinephrine
electrocautery
endoscopic clips

Question 19

Beside colonoscopy, how else will you treat diverticular disease?

Answer 19

angiography

surgery

Question 20

Patient with bleeding diverticular disease who has failed colonoscopy treatment will go through ___.

Answer 20

angiography

Question 21

What possible risks when treating bleeding diverticula?

Answer 21

ischemic events -> leading to segmental imputation (right hemi colectomy)

Question 22

When suspecting LGIB caused by malignancy we must rule out __. It is not the most common reason, but the most important to rule out

Answer 22

CRC

Question 23

What types of hemorrhoids tend to bleed more?

Answer 23

internal- they do not hurt

Question 24

Which IBD causing colitis tends to bleed more?

Answer 24

UC

Question 25

Which microbes can cause LGIB colitis? (5)

Answer 25

campylobacter
CD
E. Coli
CMV

Question 26

Name 5 etiologies for small bowel bleeding

Answer 26

angiodysplasia
erosion/ulcer
Crohn's
Radiation
Meckel's

Question 27

Name 7 etiologies for colon bleeding

Answer 27

diverticular disease
anorectal disease
ischemia 
neoplasia
colitis
IBD
radiation