Lower GI bleeding

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Lower GI bleeding
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intro

• distal to the ligament of Treitz
• diverticular disease, colitis, adenomatous
  polyps, and malignancies
• Estimated that 80 of lower GI bleeds will
  resolve spontaneously

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pathyophys

• Diverticulosis
• Right sided actually more likely to bleed
• Vascular ectasia
• AV malformation
• Mesenteric ischemia and ischemic colitis
• Age, CHF, a fib, postprandial pain
• Meckels

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Clinical features

• History
• Medications
• Previous bleeding
• Associated symtoms
• Physical exam
• Vitals
• Gross blood on rectal exam

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diagnosis

• Lab
• CBC, type and cross, coags, electrolytes
• Diagnostic studies
• angiography, scintigraphy, or colonoscopy

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treatment

• Primary
• ABCs
• 2 liters of fluids
• transfusion
• Secondary
• Endoscopy
• surgery

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disposition

• Predictive of serious lower GI bleed
• hemodynamic instability
• repeated hematochezia within 4 hours of
  evaluation
• nontender abdomen
• aspirin use
• more than two comorbid conditions.

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reference

• Tintinall ch. 79