Lower GI Bleed- Bernadino Flashcards
Top 2 causes of lower GI Bleeds in adult population?
- Diverticular hemorrhage
- Angiodysplasia
*Both of colonic source!
Difference between
Diverticulosis
Diverticulitis
Diverticular hemorrhage
Diverticulosis = many false diverticula of the colon, commonly sigmoid
Diverticulitis = inflammation of diverticula
Diverticular hemorrhage = when they bleed
2 Contributing factors to diverticulosis?
- Focal weakness in luminal wall (usually where blood vessel enters)
- Associated with low fiber diets that increase intraluminal pressure
In western culture, which part of the colon is most likely to have diverticuli?
The left side
65% occur in sigmoid alone
LLQ pain Fever Leukocytosis Abdominal tenderness Sometimes diarrhea
What do you think it is….
Diverticulitis
Does diverticular hemorrhage usually treat itself?
Yup! might need a few days in ICU, but unlikely to find bleed with scope
What is angioectasia/angiodysplasia?
Tortous, dilated submucosal capillaries/veins lacking smooth muscle
Causes of non-occlusive ischemic colitis?
Hypoperfusion Drugs Heart Disease Exercise Idiopathic
Causes of occlusive ischemic colitis?
Embolic A Fib Mesenteric Vein thrombosis Vascular procedure Vasculitis
ACUTE onset severe abdominal pain followed by self-limited hematochezia (bright blood)….. what do you think it is?
Ischemia Colitis
What are common watershed areas?
Splenic flexure
Distal Colon
Which is worse right sided or left sided ischemic colitis?
Right sided!
Most likely involves small bowel also (because of superior mesenteric artery)
Management of ischemic colitis?
Improve perfusion!
Correct underlying cause
Self-limited- colonoscopy not indicated
Elective colonoscopy 6-8 weeks out to rule out other causes (strictures, etc)
L or R colon neoplasm associated with anemia?
R
R or left colon neoplasm associated with obstruction?
L (stool is more solid there)
