Acute lower GI bleed

Question 1

What are the 4 types/subsections of lower GI bleed?

Answer 1

Anatomical
Vascular
Neoplasm
Inflammatory (infectious and non-infectious)

Question 2

How does it present?

Answer 2

Maroon stools if right side colon
Bright red per rectum if left side
Melena if caecum
(although NB if bleeding is large then bright red could be present even in right sided or upper GI bleed)
Associated symptoms vary depending on aetiology.
Low BP
Fever, dehydration, cramps - colitis

Question 3

Investigation

Answer 3

Colonoscopy
Angiography if this fails
Bloods- FBC, electrolytes, coagulation screen

Question 4

Management

Answer 4

Resus- large bore IV access
Haemostasis- once bleeding site localised. Depends on cause. e.g. diverticular bleeding- colonoscopy with coag/adrenaline/clips
e.g. recurrent bleeding- resection of the segment
If can’t find site, then can administer vasoconstrictive agents such as vasopressin.
If persistent/recurrent/lots of transfusion then surgery

Question 5

Causes of LGIB

Answer 5

Diverticulosis (60%)
Angiodysplasia
Colitis (IBD)
Carcinoma
Anorectal disease (haemorrhoids, anal fissures, anorectal fistulae)
Postpolypectomy

Question 6

Examination

Answer 6

Can place NG tube to see if UGIB (brisk UGIB can present as Lower)
PR exam
Proctosigmoidoscopy