Lower gastrointestinal bleeding resident survival guide: Difference between revisions
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❑ Previous GI bleed<br>❑ Use of NSAIDs, [[aspirin]] or [[anticoagulants]]<br>❑ History of radiation<br>❑ History of liver disease<br>❑ History of [[IBD]]<br>❑ Recent [[polypectomy]]<br>❑ Family history of [[colorectal cancer]]</div>}} | ❑ Previous GI bleed<br>❑ Use of NSAIDs, [[aspirin]] or [[anticoagulants]]<br>❑ History of radiation<br>❑ History of liver disease<br>❑ History of [[IBD]]<br>❑ Recent [[polypectomy]]<br>❑ Family history of [[colorectal cancer]]</div>}} | ||
{{familytree | | | | |!| | | | | | | | | | | | }} | {{familytree | | | | |!| | | | | | | | | | | | }} | ||
{{familytree | | | | B01 | | | | | | | | | | | {{familytree | | | | B01 |-|-| B02 |-| B03 | | | B01=<div style="float: left; text-align: left; height: 6em; width: 20em; padding:1em;">Examine the patient<br> | ||
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❑ '''Assess hemodynamic status'''<br> | |||
❑ Digital rectal examination<br> | |||
❑ Stool examination for [[occult blood]]</div>|B02= [[Hematochezia]] PLUS<br> [[hemodynamic instability]]|B03=Nasogastric lavage<br>(to rule out UGIB)}} | |||
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Revision as of 19:26, 29 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Definition
Lower GI bleed refers to any bleeding originating from gastrointestinal tract distal to ligament of Treitz.
- Acute GI bleed: Defined as bleeding occurring for less than 3 days.
- Chronic GI bleed: Defined as slow and intermittent bleeding occurring over a duration of several days.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Any severe GI bleed can be life threatening and should be managed appropriately irrespective of the cause.
Common Causes
- Diverticulosis
- Colitis
- Angiodysplasia
- Colon cancer
- Radiation enteritis
- Inflammatory bowel disease
- Anorectal disorders
Management
Shown below is an algorithm summarizing the approach to [[disease name]].
Characterize the symptoms ❑ Frank blood per rectum (bleeding from left colon) Obtain past medical history: ❑ Use of NSAIDs, aspirin or anticoagulants ❑ History of radiation ❑ History of liver disease ❑ History of IBD ❑ Recent polypectomy ❑ Family history of colorectal cancer | |||||||||||||||||||||||||||||||||
Examine the patient ❑ Assess hemodynamic status | Hematochezia PLUS hemodynamic instability | Nasogastric lavage (to rule out UGIB) | |||||||||||||||||||||||||||||||