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ANKI GI > [36] Lower GI Bleed > Flashcards

[36] Lower GI Bleed Flashcards

1
Q

What are the common or important causes of lower GI bleeding?

A

Haemorrhoids or fissures
Diverticulitis
Neoplasm

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2
Q

What are the other causes of lower GI bleeding?

A 
Inflammation 
Infection
Polyps
Large upper GI bleed
Angio causes
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3
Q

Give an example of an inflammatory cause of lower GI bleed

A

Inflammatory bowel disease

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4
Q

Give 3 infectious causes of lower GI bleeds

A

Shigella
Campylobacter
C. diff

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5
Q

What % of lower GI bleeds are caused by large upper GI bleeds?

A

15%

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6
Q

What are the angio causes of lower GI bleeds?

A

Dysplasia
Ischaemic colitis
Hereditary hemorrhagic telangiectasia

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7
Q

How are lower GI bleeds investigated?

A

Bloods
Stool MC&S
Imaging
Endoscopy

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8
Q

What bloods are done in lower GI bleeds?

A 
FBC
U&E
LFT
Cross match
Clotting
Amylase
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9
Q

What imaging may be done in lower GI bleeds?

A

AXR and erect CXR
Angiography
Red cell scan

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10
Q

When may angiography be necessary in lower GI bleeds?

A

If no source on endoscopy

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11
Q

What is the first line endoscopy technique in lower GI bleeds?

A

Rigid proctoscopy/sigmoidoscopy

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12
Q

What is the second line endoscopy technique in lower GI bleeds?

A

OGD

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13
Q

What is the 3rd line endoscopy technique in lower GI bleeds?

A

Colonoscopy

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14
Q

What is the problem with colonoscopy in lower GI bleeds?

A

It is difficult in major bleeding

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15
Q

How are lower GI bleeds managed?

A 
Resuscitation 
Urinary catheter
Abx
PPI
Keep bed bound
Stool chart
Clear fluids only
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16
Q

When are Abx required in lower GI bleeds?

A

If evidence of sepsis or perforation

17
Q

When are PPIs given in lower GI bleeds?

A

If an upper GI bleed is possible

18
Q

Why should you keep a patient with a lower GI bleed bed bound?

A

The need to pass stool may actually be a large bleed, which could lead to collapse

19
Q

Why should you keep a patient with a lower GI bleed on clear fluids only?

A

Allows for colonoscopy

20
Q

What is angiodysplasia?

A

Submucosal AV malformations

21
Q

Where does angiodysplasia occur?

A

70-90% occur in right colon, however can affect anywhere in GIT

22
Q

Who does angiodysplasia present in?

A

Elderly

23
Q

How does angiodysplasia present?

A

Fresh PR bleeding

24
Q

How might other differentials be ruled out in angiodysplasia?

A

PR exam
Ba enema
Colonoscopy

25
Q

What investigations may be done in angiodysplasia?

A

Mesenteric angiography or CT angiography

Tc-labelled RBC scan

26
Q

What is the purpose of a Tc-labelled RBC scan?

A

Identifies active bleeding

27
Q

How is angiodysplasia managed?

A

Embolisation
Endoscopic laser electrocoagulation
Resection

ANKI GI (43 decks)

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