Lower GI Bleeds Clinical Lecture Flashcards
Diverticular bleeding is often from this source
arterial bleeding
arteries go through colon wall where where diverticula form (weakness in wall)
Ischemic colitis presentation
acute onset of pain
self-limited hematochezia
Ischemic colitis most often occurs here
watershed area of SMA and IMA
splenic flexure
Why does the hepatic flexure not often become ischemic?
if it did, that would be an SMA occlusion and would be bad for the entire midgut
Tx of ischemic colitis
observation
fluids to increase volume –> improve perfusion
Etiologies of ischemic colitis
non-occlusive: hypotension
occlusive: thrombi
Neoplasm
left vs right colon
left: obstruction (firmer stool)
right: anemia
Radiation proctitis
most commonly from
prostate cancer treatment
Hemorrhoids become painful when they
thrombose
Solitary rectal ulcer etiologies
puborectalis muscle spasm, rectal prolapse, constipation, 4th decade of life
Diveritcular bleeding
what % of people with diverticulosis
33% ie 1/3
Tx of diverticular bleeding
observe
80% of time is self-limited
banding if needed
