Lower GI bleed

Question 1

What questions should be asked in the history upon presentation of a lower GI bleed?

Answer 1

How much blood?
Colour? - Darker indicates left/transverse colon.
Mixed in with stool? - Separate = anal pathology.
Other bowel changes?
Weight loss?
Tenesmus?
Anal soreness or itching?

Question 2

What bloods should be performed upon presentation of a lower GI bleed?

Answer 2

FBC, ferritin, coagulation, LFTs, faecal.

Question 3

What imaging should be performed upon presentation of a lower GI bleed?

Answer 3

Flexi sig in young patients.

Colonoscopy if suspecting cancer as can biopsy from it.

Question 4

When is acute management of bleeding needed?

Answer 4

Patient >60.
Haemodynamic disturbance.
Massive bleeding.
Co-morbidities.

Question 5

What is the acute management of bleeding?

Answer 5

1. ABC
2. History and examination.
3. Full bloods including amylase and crossmatch.
4. Plain AXR.
5. IV fluids.
6. Reverse any anticoagulants.
7. Keep bed bound and don’t allow to toilet.
8. Stool chart.