Lower GI Bleed Management Flashcards
What is melena?
Dark, tarry stools resulting from upper GI bleeding
Melena occurs due to the digestion of blood as it passes through the gastrointestinal tract.
What is haematochezia?
Fresh red blood in the stool, indicating lower GI bleeding
Haematochezia typically suggests a more distal source of bleeding.
What are common symptoms of lower GI bleeding?
- Melena or haematochezia
- Quantity of blood
- Pain
- Change in bowel habit
- PR mucus
- Symptoms of iron deficiency anemia (IDA)
- Liver disease signs
Symptoms can vary based on the underlying cause of the bleeding.
What does the presence of PR mucus suggest?
Possible inflammatory bowel disease (IBD) or infection
Mucus in stool may indicate underlying pathology requiring further investigation.
What is the most common cause of lower GI bleeding?
Diverticular disease
Painless bleeding is associated with diverticular disease, whereas painful bleeding indicates diverticulosis.
DDx of lower GI bleed
What are the characteristics of hemorrhoids?
- Present as a mass
- Pruritus
- Fresh-red rectal bleeding
- Blood on the surface of stool
Large hemorrhoids may thrombose, causing significant pain.
What is the typical presentation of an anal fissure?
Painful, bright red rectal bleeding, often occurring in the posterior midline
Alternate locations of fissures may suggest other underlying conditions.
What are the key features of colorectal cancer (CRC) or polyps?
- Weight loss
- Iron deficiency anemia (IDA)
- Family history
These features can indicate a higher risk of malignancy.
What is the score used to stratify patients presentingh with lower GI bleed?
The Oakland score can be used to stratify patients presenting with a lower GI bleed to determine if outpatient management is suitable.
What initial blood tests should be performed for suspected lower GI bleeding?
- Full blood count (FBC)
- Urea and electrolytes (U&E) - raised urea:creatinine ratio => upper GI bleed
- C-reactive protein (CRP)
- Liver function tests (LFTs)
- Group and crossmatch
These tests help assess the patient’s hemodynamic status and potential causes of bleeding.
What imaging is recommended for unstable patients with lower GI bleeding?
CT angiogram after resuscitation
This imaging helps identify the source of bleeding and allows for therapeutic embolization.
What is the first-line treatment for most cases of lower GI bleeding?
95% of cases will settle spontaneously
Stable, low-risk patients can often be managed as outpatients.
What are endoscopic haemostasis methods?
- Injection (diluted adrenaline)
- Contact and non-contact thermal devices
- Mechanical therapies (endoscopic clips and band ligation)
- Arterial embolization
These methods are used to control bleeding during endoscopy.
What is the rule of 2’s in relation to Meckel’s diverticulum?
- 2% of the population
- 2 feet from ileocecal valve
- 2 inches long
Meckel’s diverticulum typically presents in children aged 1-2 years.
What factors can indicate the need for surgical intervention in lower GI bleeding?
Ongoing lower GI bleeding where endoscopic or radiographic treatment has failed
Surgical options are considered when less invasive methods are ineffective.
