APPROACH TO LOWER GI BLEED

Question 1

FEATURES OF OCCULT LOWER GI BLEED

Answer 1

Any age
Slow, chronic bleeding
Microcytic hypochromic anaemia
Positive Faceal Occult Blood Test (FOBT)

Question 2

FEATURES OF MODERATE LOWER GI BLEEDING

Answer 2

Any age
Melena or haematochezia
Haemodynamically stable

Question 3

6 FEATURES OF SEVERE LOWER GI BLEEDING

Answer 3

> 65 years old
Systolic BP< 90bpm
Heart Rate> 100bpm
Low urine output
Low haemoglobin
Prominent haematochezia

Question 4

COMMON CAUSES OF LOWER GI BLEED IN ORDER

Answer 4

1. Diverticulosis
   2.Anorectal disease
   3.Ischemia
2. Inflammatory Bowel Disease (IBD)
3. Neoplasia
4. AV malformations

Question 5

5 Meckel’s diverticulum complications

Answer 5

Haemorrhage
Diverticulitis
Hernia
Tumour
Inflammation

Question 6

Best choice for detecting Meckel’s diverticulum

Answer 6

Technetium 99m pertechnetate scan

Question 7

Mx of Meckel’s diverticulum

Answer 7

Surgical resection

Question 8

Meckel’s diverticulum is the remnant of…

Answer 8

Vestigial remnant of the Vitelline duct

Question 9

The initial diagnostic of choice in lower GI Bleed

Answer 9

Colonoscopy

Question 10

Intervention via colonoscopy

Answer 10

Clips
Adrenaline injection
Thermoregulation
Laser photocoagulation

Question 11

Workup and initial Rx in lower GI Bleed

Answer 11

Resuscitation
Exclude upper GI bleed ( NGT lavage and upper endoscopy) if necessary
Colonoscopy
Nuclear scintigraphy
Angiography
Surgical intervention

Question 12

Interventions during angiography in lower GI Bleed

Answer 12

Selective vasopressin infusions
Superselective angioembolisation

Question 13

In patients with massive lower GI bleeding, if colonoscopy fails to identify and control the site of haemorrhage…

Answer 13

Transarterial embolisation can be performed

Question 14

Indications for emergency surgery in lower GI bleed

Answer 14

Haemodynamic instability with active bleeding
Persistent recurrent bleeding
Transfusion requirement of > 6 units of PRBCs in 24hrs with active bleeding

Question 15

If bleeding can’t be localised in surgical intervention of lower GI Bleed

Answer 15

Subtotal colectomy

Question 16

Intraoperative enteroscopy (IOE) indications

Answer 16

1.small bowel lesions have been identified by a preoperative work-up;
2.lesions cannot be managed by angioembolization and/or endoscopic methods, or when surgery is required for complete treatment (i.e., small bowel tumours)
3.bleeding cannot be localized during surgical explorations.