Lower GI Bleeding

Question 1

ESSENCE

Answer 1

Lower GI bleed usually results from bleeding from colon or rectum

Question 2

AETIOLOGY

Risk factors

Answer 2

• Diverticulosis
• Angiodysplasia
• Ischaemic colitis
• Neoplasm
• IBD
• Infection - salmonella and shigella
• Haemorrhoids
• Anal fissure

Question 3

AETIOLOGY

Common infection causes

Answer 3

Salmonella and shigella

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Rectal bleeding
  
  • Bright red if from left side colon
  • Maroon blood if from right side
• Fever if infectious
• Maybe abdominal pain

Question 5

INVESTIGATIONS

First choice

Answer 5

• Colonoscopy - first line
• Angiography if haemodynamically unstable
• Serum labs
  
  • FBC
  • Electrolytes
  • Coagulation

Question 6

COMPLICATIONS

Answer 6

• Shock
• Death

Question 7

MANAGEMENT

General principles

Answer 7

• Resuscitation
• Colonoscopy
• Angiography if colonoscopy unreaveling or contraindicated
• Surgical exploration in unstable patients or persistent bleeding