GI - Lower GI Bleeding Flashcards
1
Q
Name the most common/important causes of lower GI bleed and other, less important/common ones
A
- Rectal (haemorrhoids/fissure), diverticulitis, neoplasm
- Other: inflammation (IBD), infection (shigella, campy, c diff), polyps, larger upper GI bleed, angio (dysplasia, ischaemic colitis, and HHT [hereditary haemorrhage telangiectasia])
2
Q
Ix: bloods and stool
A
- Bloods: FBC, U&E, LFT, X match, clotting, amylase
- Stool: MCS test (blue stool bottle)
3
Q
Ix: imaging
A
- AXR, eCXR
- Angiography: necessary if source not found on endoscopy
- Red cell scan
4
Q
Ix: endoscopy
A
- Rigid proctoscopy/sigmoidoscopy
- OGD
- Colonoscopy: difficult in major bleeding
5
Q
Mx:
A
- ABCDE approach
- IV fluid resus
- Urinary catheter
- ABX: if evidence of sepsis or perforation
- PPI: if upper GI bleed suspected/possible
- Keep bed bound: need to pass stool may lead to a large bleed and a collapse, best to be in bed when it happens
- Stool chart + I/O
- Diet: keep on clear fluids (allows colonoscopy)
- Surgery: only if unremitting, massive bleed
6
Q
Angiodysplasia: what is it?
A
- Degenerative lesion, acquired, probably resulting from chronic and intermittent contraction of the colon that obstructs venous drainage of mucosa.
- With time: veins become more and more tortuous, while the capillaries of the mucosa gradually dilate and precapillary sphincter becomes incompetent.
- T/f get formation of AV malformation characterized by a small tuft of dilated vessels.
- Most common is caecum and ascending colon
7
Q
Angiodysplasia: presentation
A
- Elderly patients
- Fresh PR bleeding
- Some pts can have melena while others only have an anaemia
- faecal occult screening may not pick it up if disease not active at the time
8
Q
Angiodysplasia: Ix
A
- Exclude other Dx with PR exam, BA enema, colonoscopy, mesenteric angiography or CT angiography
- Tc-labelled RBC scan: identify active bleeding
9
Q
Angiodysplasia: Rx
A
- Embolisation
- Endoscopic laser electrocoagulation
- Resection
