Lower GIT bleeding Flashcards
Definition of lower GIT bleeding
GI bleeding below the ligament of treitz and is mostly self limiting
Explain the different classification of lower GI bleeding
Massive:
Moderate:
Occult
What is the presentation of a patient with massive bleed and possible causes
Bright red blood - ongoing bleed
Low BP <100mmHg
Pulse >100
Low urine output
HB <6G/DL
- > 65 years
- Comorbidities
- Antiplatelets, anticoagulants
Caused by: Diverticular disease (most common cause), Diealafoys vessel, AV malformation
What is the presentation of a patient with moderate bleed and possible causes
Any age
Melena
Haemodynamically stable
Causes:
- Neoplasm
- Inflammatory
- Infections
- Benign
Explain the presentation of a patient with occult bleeding and possible causes
Any age
Chronic
Picked up in lab, Microcytic hypochromic anaemia,
Positive occult stool test
Causes
- Inflammatory
- Neoplastic
- Congenital
What is diverticular disease presentation
Painless hematochezia
80% will stop spontaneously
Occurs in older patients
Mostly affects left colon
What is Dielafoys vessel presentation
Large artery in the mucosa
Rupture spontaneously
Massive bleed
Explain ischaemic colitis
Found in elderly patients
Reduced mesenteric flow to the colon
- Cardic failure
- Vasospasm
- Atherosclerosis
Water shed areas affected
Painflul bleed
What are the most common causes of GI bleeding in patients younger than 50
Hemorrhoids
Inflammatory bowel disease
NSAIDs use
Vascular ectasias
Explain the evaluation of a atient with GI bleed
History questions:
* Is it recurrent/sporadic
* Scant/massive
* Associated symptoms? (Pain, weight loss, swellings)
* Medication use
Exam:
- Abdominal
- Rectal examination: Bright red - Left colon bleed, Maroon: Right colon
What are the important laboratory tests and why in GI bleed
FBC
- Plateletts: could be sign of chronic bleed
U/E
- Reduced perfusion of kidneys due to bleed affects platelet function
Lactate
Coagulation studies
What is the triage procedure for a patient with lower GI bleed
ABC
O2
Two large bore peripheral IV drip
ECG
Crystalloids IVI
Blood transfusions - determinded by Hb (7.5) and patients age
Explain the B,L,E,E,D citeria
B - Bright red - Ongoing bleed, Melena - patient has stopped bleeding
L - Low BP
E - Elevated >1.2 INR
E - Erratic mental state
D - Unstable comorbid Disease
Any of these means ICU/High care
What is the treatment of Lower GI bleed
Multidisciplinary approach
Colonoscopy should be done within 24hours after bowel prep
Diverticular disease: Adrenalin 1:10000 in 1ml to inject 1-2 mls at the site
Imaging modalities:
If not stable: CTA (CT angiogram), 3-5ml/min of bleeding needed
CATH angio in unstable continue bleeding
Radionuclide 99TC in scant bleed
If patient remains haemodynamically unstable and needs >6units in 24hours and nor responding to resus
- Emergency segmental resection
- Subtotal colectotomy
