Lower GI bleeding Flashcards

1
Q

What are the causes of lower GI bleeding?

A
  • erosive or inflammatory
  • vascular
  • tumors -> colorectal/anal cancer & colonic polyps
  • anal fissures
  • trauma
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2
Q

What are the erosive/inflammatory causes of lower GI bleeding?

A
  • diverticulosis
  • inflammatory bowel disease
  • invasive or inflammatory diarrhea (Shigella)
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3
Q

What are the vascular causes of lower GI bleeding?

A
  • hemorrhoids
  • ischemia
  • arteriovenous malformation -> angiodysplasia (right side colon)
  • rectal varices
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4
Q

What are the traumatic causes of lower GI bleeding?

A
  • lower abdominal trauma
  • anorectal trauma (anorectal avulsion, impalement injuries
  • during or after surgery or endoscopic procedure
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5
Q

What are the clinical features of lower GI bleeding?

A
  • anemia due to chronic blood loss

- acute hemorrhage -> hypovolemic shock

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6
Q

How should a patient with lower GI bleeding be managed?

A
  • all patients -> 2 large-bore peripheral IVs
  • stable -> restrictive transfusion strategy
  • unstable -> ABCDE
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7
Q

What are the investigations used to diagnose lower GI bleeding?

A
  • COLONONSCOPY gold standard -> high risk patients
    - > history of polyps IBD
    - > multiple episodes of massive bleeding
  • endoscopy -> identify source of bleeding
  • proctosigmoidoscopy -> in mild bleeding
    - > low risk patients
    - > in anal canal conditions
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8
Q

What are the indications of angiography?

A
  • GI bleeding & hemodynamically instability
  • patients with rebreeding or ongoing bleeding despite endoscopic hemostasis
  • angioembolization
  • intraarterial vasopressin
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9
Q

What are the indications for surgery in lower GI bleeding?

A
  • if other therapies failed
  • diverticulosis
  • IBD
  • colorectal carcinoma
  • polyps
  • hemorrhoidal bleeding
  • angiodysplasias
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10
Q

When is capsule endoscopy used?

A

in obscure GI bleeding usually from the small bowel

- balloon enteroscopy is therapeutic

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