Lower GI Bleeding Flashcards
What is lower GI bleeding?
Bleeding distal to the ligament of Treitz, typically from the colon.
What are the symptoms of lower GI bleeding?
Hematochezia, +/- abdominal pain, melena, anorexia, fatigue, syncope, SOB, shock.
What are the signs of lower GI bleeding?
BRBPR, positive hemoccult, abdominal tenderness, hypovolemic shock, orthostasis.
What are the causes of lower GI bleeding?
Diverticulitis, intussusception, volvulus, Meckel’s diverticulum, aortoenteric fistula, strangulated hernia, vascular ectasia, hemorrhoids, hereditary hemorrhagic telangiectasia, infarcted bowel, colon cancer, rectal cancer, trauma, ischemic colitis, IBD, anticoagulation, stercoral ulcer, infectious colitis, chemotherapy, irradiation, anal fissure.
What medicines should be looked for causally with a lower GI bleed?
Coumadin, aspirin, Plavix.
What are the most common causes of massive lower GI bleeding?
- Diverticulosis
2. Vascular ectasia
What lab tests should be performed for lower GI bleeding?
CBC, BMP, PT/PTT, T&C
What is the initial treatment of lower GI bleeding?
IVFs (e.g. lactated Ringer’s); packed RBCs; Foley; d/c aspirin, NGT
What diagnostic tests should be performed for all lower GI bleeds?
H&P, NGT aspiration (r/o UGI bleeding; if no bile or blood, perform EGD), anoscopy or proctoscopy
What must be ruled out in patients with lower GI bleeding?
Upper GI bleeding.
How can you have a UGI bleed with only clear succus back in the NGT?
Bleeding DU can bleed distal to the pylorus with the NGT sucking normal non-bloody gastric secretions.
What is the diagnostic test of choice for localizing a slow to moderate lower GI bleeding source?
Colonoscopy
What test is performed to localize lower GI bleeding if there is too much active bleeding to see the source with a colonoscopy?
A-gram (mesenteric angiography)
What is more sensitive for a slow, intermittent amount of lower GI blood loss: A-gram or tagged RBC study?
Radiolabeled RBC scan (for arteriography, bleeding rate must be > 1.0 mL/min).
What is the colonoscopic treatment option for a bleeding vascular ectasia or polyp?
Laser or electrocoagulation; local epinephrine injection.
What is the treatment if bleeding site is known and massive or recurrent lower GI bleeding continues?
Segmental resection of the bowel.
What is the surgical treatment of massive lower GI bleeding without localization?
Exploratory laparotomy with intraoperative enteroscopy and total abdominal colectomy as last resort
What percentage of cases of lower GI bleeding spontaneously stop bleeding?
80-90% stop bleeding with resuscitative measures only
What percentage of patients with lower GI bleeding require emergent surgery?
10%
Does melena always signify active colonic bleeding?
NO. The colon is good at storing material and can pass melena days after bleed.
What is the therapeutic advantage of doing a colonoscopy? (2)
Have the option of injecting epinephrine or coagulating vessels
What is the therapeutic advantage of doing an A-gram for a lower GI bleed? (2)
Have the option to injecting vasopressin or embolization
