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
2
Q
What are the erosive/inflammatory causes of lower GI bleeding?
A
- diverticulosis
- inflammatory bowel disease
- invasive or inflammatory diarrhea (Shigella)
3
Q
What are the vascular causes of lower GI bleeding?
A
- hemorrhoids
- ischemia
- arteriovenous malformation -> angiodysplasia (right side colon)
- rectal varices
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
5
Q
What are the clinical features of lower GI bleeding?
A
- anemia due to chronic blood loss
- acute hemorrhage -> hypovolemic shock
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
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
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
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
10
Q
When is capsule endoscopy used?
A
in obscure GI bleeding usually from the small bowel
- balloon enteroscopy is therapeutic
