Lower GIT bleeding Flashcards
Definition of lower GIT bleeding
Gastrointestinal bleeding that occurs distal to ligament of Treitz
How does massive lower GIT bleeding usually present
- Passage of large amounts of red or maroon blood per rectum (Haematochezia)
- Haemodynamic instability or shock
- An initial haemoglobin of 8 g/dl or less
- The need to transfuse more than 2 U of blood
- Bleeding that continues for three days
- Significant rebleeding within a week
How do patients with chronic bleeding usually present
- Small amounts of blood in their stools
- Additionally they may present faecal occult blood postitivity or iron defiency anaemia
What is occult LGIB
Patients show evidence of blood loss without any obvious signs or symptoms. It is detected with a postive faecal occult blood test
Likely cause in younger patient with abdominal pain, diarrhea and rectal bleeding
inflammatory bowel disease
Likely cause in older patient with weight loss and iron deficiency anaemia
large caecal tumour
What proportion of patients will have acute bleeding that stops spontaneously
80 %
Overall mortality of LGIB
2-4 %
Most common causes of LGIB
- Diverticulosis
- Angiodysplasia
- colitis
- Neoplasia
- Haemorrhoids and other anorectal disorders
- Drug related
What is diverticulosis and which part of the GIT does it usually affect
Presence of pouchlike herniations through the muscular layers of the colon. It most commonly affects the sigmoid colon but can affect the entire colon
How does diverticula bleeding usually present
Usually presents with acute, painless, bright red bleeding
What is angiodysplasia
Degenerative vascular malformations of the GIT characterized by fragile blood vessels leading to GIT and anaemia
Which part of the GIT does angiodysplasia affect
Caecum and ascending colon
What percentage of acute LGIB is due to angiodysplasia
5%
How does ischaemic colitis usually present and which part of the GIT does it affect
- presents with abdominal pain associated with haematochezia
- it affects the watershed areas of the colon- the splenic flexure and rectosigmoid colon
How does inflammatory bowel disease usually present
- Do not commonly cause massive LGIB but do cause bloody diarrhea that may lead to an iron deficiency anaemia
What type of bleeding do polyps and carcinomas cause
The bleeding is usually low grade and often leads to iron deficiency anaemia
What laboratory testing should one do for patients with LGIB
Full blood count with platelets. Clotting factors should be checked. Specimen taken to cross match in patients with an acute bleed
When are plain abdominal X-rays useful
Rectal bleeding related to inflammatory bowel disease
What is the bleeding rate required to detect bleeding on CT scan
CT scanning will pick up bleeding from 1 ml/minute
What is the bleeding rate required for radioisotope scans to pick up bleeding
It will localize bleeding from 0.1 ml/ minute
Which is the preferred method of interventional radiology?
Angioembolisation
What is the primary diagnostic and therapeutic modality in LGIB?
Endoscopy- all patients presenting with LGIB Should have upper endoscopy performed to exclude any proximal cause of the bleeding
What are the three phases of therapeutic approach to LGIB
- Resusciation
- localization of bleeding point
- haemostasis
