Lower GI Bleed Flashcards
(19 cards)
Most common source of lower GI bleeding
Colon - 85%
Small Bowel - 5%
Upper GI source - 10%
Some things in the small bowel that can cause bleeds
Angioectasia ulcers from celiac cmv IBD fistula diverticular hemorrhage Meckel's
Most common causes of Colon bleeds
Diverticular hemorrhage - 20-50% Angiodisplasia - 20-30% ischemia neoplasm radiation
Where do most diverticua happen in the colon?
Left side (descending, sigmoid) except asians. they're always on the wrong side because they're socially inept.
What predisposes you to diverticulosis?
Age
5-10% > 40yo
60% have it at age 60
80% have it at age 85
Symptoms of diverticulitis
Pain, diarrhea, LUQ abdominal tenderness. fever, leukocytosis. hemorrhage is rare
occurs in 10% of people with diverticulosis
Treatment for diverticulitis
antibiotics metronidazole and cipro. or amox/clavulantae
if it’s real bad and they’re old, hospital - iv antibiotics, NPO
if septic/perforation - surgery
What do you do for most diverticular hemorrhages?
wait it out. 80% are self-limited
If you have to actually treat diverticular hemorrhage, what do you do?
reverse anticoagulation, trasfuse, resuscitate
if persistent, colonoscopy w/ clipping, cautery
What is angioectasia?
big ole blood vessels without smooth muscle, usually in right colon
present as hemorrhage or anemia.
they look spidery
Ischemic colitis. there are two types. what are they and what causes them?
Non-occlusive - hypoperfusion, heart disease, exercise, drugs
Occlusive - embolism, a fib, hypercoagulable state
Ischemic colitis happens where, usually?
watershed areas.
OH GAWWD my stomach started hurting real bad out of nowhere. and hour later I shit bright blood. GAWWWD. LORD WHY???
The Lord says, “Nancy, you 42 y/o woman, you have ischemic colitis. Maybe because you smoke. Stop smoking, you bitch.” Amen!
Whelp, you know your anemia? Turns out it’s from colon cancer. That sucks. Guess if it’s on the left or right side.
Right causes anemia
Left causes obstruction.
10 years ago, you prostate was overweight. Then you got radiation, now you have pain, diarrhea and bleed sometimes. What’s that about?
Oh, it’s called Radiation proctitis. It happens. sometimes years later.
Owwwy. I’m usually constipated and I sit and play gameboy on the toilet a lot and now it hurts when I poopy.
Son, you’ve got an anal fissure. they’re usually posterior.
We’re gonna have to give you a lot of fiber to bulk up/soften your stools
Ways to treat and anal fissure.
stool softener (fiber)
topical calcium blocker or nitrate (nitro, diltiazem, nifedipine)
botulism
sphincterotomy
Hemorrhoids can be internal or external. Which ones hurt?
External.
both are dilated veins.
What disease can be erythema, nodule or ulcer, many times from rectal prolapse?
Treatment?
Solitary rectal ulcer.
tx - softeners, mesalamine (nasaid), steroids or surgery
