Lower GI bleed and Mesenteric ischaemia Flashcards Preview

Year 3 Lower GI Surgery > Lower GI bleed and Mesenteric ischaemia > Flashcards

Flashcards in Lower GI bleed and Mesenteric ischaemia Deck (8)
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1

Causes of mesenteric ischaemia

• Arterial thrombosis or embolism
• Non-occlusive: Splanchnic vasoconstriction: e.g. secondary to shock
• Venous thrombosis
• Trauma, vasculitis, strangulation

2

Presentation of mesenteric ischaemia

• Nearly always small bowel

• Triad:
- Acute severe abdominal pain ± PR bleed
- Rapid hypovolaemia → shock
- No abdominal signs

• Degree of illness > clinical signs

3

Investigations of mesenteric ischaemia

Bloods
- ↑Hb: plasma loss
- ↑WCC
- ↑ amylase
- Persistent metabolic acidosis: ↑lactate

• Imaging
- AXR: gasless abdomen
- Arteriography / CT/MRI ang

4

Complications of mesenteric ishchaemia

Septic peritonitis

5

Mx of mesenteric ischaemia

• Fluids
• Abx: gent + met
• LMWH
• Laparotomy: resect necrotic bowel

6

Causes of lower GI bleeding

• Rectal: haemorrhoids, fissure
• Diverticulitis
• Neoplasm

• IBD
• Infection - shigella, campylobacter, salmonella
• polyps

7

Investigations for lower GI bleed

• Bloods: FBC, U+E, LFT, G+S, clotting
• Stool: MCS
• Imaging
- AXR, erect CXR
- Angiography: necessary if no source on endoscopy
• Endoscopy
- 1st: Rigid proctoscopy / sigmoidoscopy
- 2nd: OGD
- 3rd: Colonoscopy: difficult in major bleeding

8

Mx of lower GI bleed

• Resuscitate
• Urinary catheter
• Abx: if evidence of sepsis or perf
• PPI: if upper GI bleed possible
• Keep bed bound: need to pass stool may be large
bleed → collapse
• Stool chart
• Diet: keep on clear fluids (allows colonoscopy)
• Surgery: only if unremitting, massive bleed