Lower GI Bleed Flashcards
What are other differential diagnosis for lower GI bleed?
Crohn’s disease
Ulcerative Colitis
What are the symptoms of diverticular disease?
typically over 65 years of age; may be a history of recurrent left lower abdominal pain, bloating, constipation, diarrhoea; mild or severe painless haematochezia (bright red rectal bleeding), stops spontaneously in most, recurrent bleeding in 10% to 40% of patients
What are the signs of diverticular disease?
vital signs may indicate severe bleeding (e.g., systolic BP <115 mmHg, heart rate >100 bpm); abdominal examination is usually normal; rectal examination may reveal bright red blood or blood clots, may be indistinguishable from colonic angiodysplasia but bleeding is usually more profuse and more likely to cause haemodynamic instability
What first line investigations would you do in diverticular disease?
FBC: haemoglobin normal or low
platelets: normal or rarely thrombocytopenia in severe bleeding
clotting studies: usually normal
colonoscopy: active bleeding or fresh blood may be seen along with diverticulae
What other investigations would you consider in diverticular disease?
radionuclide imaging: tagged red blood cell scintigraphy demonstrates extravasation and identifies the site of bleeding
mesenteric angiography: localises the site of bleeding, if the bleeding rate is >0.5 mL/minute
What are the symptoms of colonic angiodysplasia?
typically over 65 years of age; intermittent, mild, or severe episodes of painless haematochezia (bright red rectal bleeding), may be history of end-stage renal disease, von Willebrand’s disease, aortic stenosis, or anticoagulant therapy
What are the signs of colonic angiodysplasia?
vital signs may indicate severe bleeding (e.g., systolic BP <115 mmHg, heart rate >100 bpm); signs and symptoms of anaemia may be present; abdominal examination is usually unremarkable, rectal bleeding may be indistinguishable from diverticular disease but bleeding usually less severe and less likely to cause haemodynamic instability
What first line investigations would you consider for colonic angiodysplasia?
FBC: haemoglobin normal or low
platelets: normal or rarely thrombocytopenia in severe bleeding
clotting studies: usually normal
colonoscopy: angiomas may be visualised: 5 to 10 mm cherry red, ectatic blood vessels radiating from a central vessel
What other investigations would you consider for colonic angiodysplasia?
radionuclide imaging: may localise bleeding site
mesenteric angiography: the site of active bleeding may be seen
What are the symptoms of ischaemic colitis?
age typically over 60 years, sudden-onset lower abdominal cramping, diarrhoea, and self-limited haematochezia (bright red rectal bleeding); may be history of haemodialysis, hypertension, hypo-albuminaemia, diabetes mellitus, constipation-inducing drugs
What are the signs of ischaemic colitis?
lower abdominal tenderness; presence of peritoneal signs/absence of bowel sounds may suggest trans-mural infarction or perforation
What first line investigations would you do for ischaemic colitis?
FBC: haemoglobin normal or low; WBC count may be elevated
platelets: normal
clotting studies: normal
CT scan of abdomen: segmental circumferential wall thickening
What other investigations would you consider in ischaemic colitis?
colonoscopy: petechial haemorrhages, oedema, ulceration of colonic mucosa
What are the symptoms of infectious colitis?
acute diarrhoea, abdominal pain, may be a history of travel to regions with higher risk of infectious diarrhoea
What are the signs of infectious colitis?
abdominal tenderness may be present, fever
What first line investigations would you do in infectious colitis?
stool studies: stool culture: may reveal the specific pathogen; stool white blood cell count: may be elevated; tests for ova and parasites may be positive
What are the symptoms of colorectal cancer?
typically age is over 40 years; rectal bleeding; weight loss; change in bowel movements; tenesmus, abdominal pain
What are the signs of colorectal cancer?
palpable mass may be present in the abdomen; rectal mass may be felt on digital rectal examination
What first line investigation would you consider in colorectal cancer?
colonoscopy: friable mass in the colon may be seen and biopsy is diagnostic.
What are the symptoms of internal haemorrhoids?
self-limited, intermittent, painless bright red rectal bleeding that may be chronic or intermittent; constipation may also be present; blood may be covering the stool
What are the signs of internal haemorrhoids?
general examination is usually normal
What first line investigation would you do in internal haemorrhoids?
anoscopy: internal haemorrhoids visualised
What are the symptoms of anal fissure
rectal bleeding (usually seen on wiping) and severe peri-anal pain on defecation
What are the signs of anal fissure?
fissure may be visible when parting buttocks, most commonly in the posterior midline
