GI - PR bleeding

Question 1

ΔΔ PR bleeding

Answer 1

• diverticulitis
• colorectal CA
• haemorrhoids
• IBD (mostly UC)
• perianal disease
• angiodysplasia (AV malform in elderly)
• anal fissure

rare:
• GE (campylobacter, salmonella, shigella, E.coli)
• trauma
• ischaemic colitis
• radiation (oft w/n 1 yr)

Question 2

acute Ix for PR bleed?

Answer 2

BEDSIDE:
• stool chart - MC+S

BLOODS:
•usual
• coag, amylase, group + save, crossmatch

IMAGING:
• AXR (erect CXR if perforation Sx)
• CT A-P

*colonoscopy definitive

Question 3

acute Tx for PR bleed?

Answer 3

• ABC + Ix
• fluids +/- transfusion
• CT abdo pelvis
+/- compression stockings (but don’t add LMWH)

• DHx - stop anticoag/plts
• Abx pip/taz if perforation/sepsis
• keep them still + clear fluid diet

THEN:
• *colonoscopy is definitive for localising source
• angiography + embolisation if colonoscopy fails
• if still massive bleeding - surgery

Question 4

name for if patient is passing fresh bright red blood PR?

Answer 4

“haematochezia”

15% due to upper GI cause

Question 5

PR bleed and fever?

Answer 5

IBD/GE

Question 6

PR bleed and weight loss?

Answer 6

CA

Question 7

definitive Tx for lower GI bleed?

Answer 7

colonoscopy for localisation of source and haemostasis, using Adr, diathermy +/- clipping