Acute Lower GI bleed Flashcards
Definition
Bleeding anywhere from the duodenojejunal junction to the anus.
Causes?
-Commonest cause of lower GI bleeding is upper GI haemorrhage
-20% of acute GI haemorrhage is from the colon or rectum
-Angiodysplasia and bleeding from diverticulae (most common)
-IBD
Aortic-enteric fistulae
Risk factors?
Age Co-morbidities Haemodynamic disturbance NSAIDs or aspirin Only consider discharge if small PR blood, look healthy and does not take NSAIDs or anticoagulants.
Clinical presentation
Large volumes of fresh or plum-coloured rectal bleeding may follow upper or lower GI bleeding.
Bloody diarrhoea suggests IBD or infective colitis.
Associated: weight loss, anorexia, change in bowel habits, suspicion of colonic carcinoma, ab pain. Anal pain commonly occurs with anal fissure or complication of haemorrhoids.
Syncope or postural dizziness may signify significant haemorrhage.
PMH: IBD, peptic ulcers, previous aortic surgeries with graft insertion.
Dx: salicylates, NSAIDs, corticosteroids, anticoagulants.
Fh: of peptic ulcers/IBD. Ask about –OH.
Signs
hypovolaemia and commence resuscitation. Pulse, BP (erect and supine), temp, SpO2. Examine abdo and do PR.
Differentials
Diverticular disease Colonic angiodysplasia Ischaemic/ infectious colitis UC/Crohn’s Colorectal Ca Anal fissure Colonic polyps haemorrhoids
Investigations
Colonoscopy- allows for management by endoscopic haemostasis
Mesenteric angiography/ nuclear imaging where colonoscopy CI or persistent bleeding & negative colonoscopy
Cross-matching
FBC, U&E, glucose and coagulation studies.
Perform an ECG on anyone >50.
Management
-If hypovolaemic immediate resus
-Give O2
-Monitor (cardiac, SpO2, BP monitoring
-Two large bore IV cannulae
-Give 1l of 0.9% saline or hartmann’s solution IV stat
-Insert Ng tube& urinary catheter
-Correct any coagulopathy
-Consider the need for a central venous line
Contact the surgical team and ICU
Complications
Death, Fe deficiency anaemia
