Lower GI bleed

Question 1

describe the initial assessment of a patient who presents with a lower GI bleed.

Answer 1

1st line: stables the patient (correct any haemodynamic instability)

if unstable: CT or percutaneous angiography (+ treatment of lesions i.e. coiling)

if stable: colonoscopy

if haemorrhoids suspected = proctosigmoidoscopy

if colitis with significant haemorrhage = sub-total colectomy

Question 2

what are indications for surgery ?

Answer 2

> 60 yrs
continued bleeding despite endoscopic intervention
recurrent bleeding
known CV disease and poor response to hypotension

Question 3

what surgical procedure would be performed for a lower GI bleed of unknown source?

Answer 3

laparotomy - on table colonic lavage - followed by resection

Question 4

what surgical procedure would be carried out for a life threatening lower GI bleed?

Answer 4

selective mesenteric embolisation

Question 5

when would you admit a patient with lower GI bleed?

Answer 5

> 60yrs
haemodynamically unstable / profuse PR bleeding
on aspirin or NSAIDS
significant comorbidity