LOWER GI BLEED

Question 1

DDX

Answer 1

Diverticulosis
Colitis
Adenomatous Polyps
Malignancy
Inflammatory Bowel Disease
Vascular Ectasia
AVM
Anorectal disease (fissure, hemorrhoids)
Ischemic Colitis / Mesenteric Ischemia

Question 2

DOCUMENTATION

Answer 2

CLINICAL FEATURES
Hematochezia

Syncope
Orthostatic Symptoms
Fatigue

Abdominal Pain
Abdominal Masses
Dyschezia

RISK FACTORS
PMHx: colonic diverticuli, hemorrhoids, IBD, colorectal cancer, coagulopathy.

FHx: Colon CA, IBD

Meds: NSAIDs, anticoagulants

Question 3

Labs / Imaging

Answer 3

INITIAL MANAGEMENT
ABC
MOVIE
NPO
2 large bore IVs (16 gauge)
Fluid resuscitation with IV crystalloid
Early consultation with surgery

INVESTIGATIONS
CBC
Type and Crossmatch
PT/INR
LFT
Cr
BUN
AXR