Lower GI bleed

Question 1

What is a lower GI bleed?

Answer 1

Bleed distal to the ligament of Treitz

Question 2

What are causes of lower GI bleed?

Answer 2

(Erosive/Inflammatory) Diverticulosis, Inflammatory bowel disease
(Vascular) Hemorrhoids, ischemia, rectal varices, angiodysplasia
(Tumours) Colorectal/Anal cancer, colon polyps

Question 3

What are the clinical features of lower GI bleed?

Answer 3

Anemia
Tachycardia
Hypotension
Hematochezia 
Melena 
Colonic bleeding (maroon, jelly-like traces of blood in stools)

Question 4

`How is lower GI bleeding diagnosed?

Answer 4

Colonoscopy
Angiography (imaging of blood vessels, which can be performed with or without a contrast medium)
(For small bowel bleeding) Push enteroscopy, video capsule endoscopy

Question 5

What is the treatment for lower GI bleeding?

Answer 5

(Conservative) Oxygen + Fluid supplementation, PPI, cross-matching
(Interventional treatment) Emergency EGD (Injection therapy (epinephrine), sclerotherapy, ligation, or thermal coagulation), angiography (vasoconstriction via vasopressin), surgical laparotomy