Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

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Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding

Transcript of Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

Page 1: Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

Antonio. Aramburo. Arcilla. Argana

Approach to a Patient with Lower GI Bleeding

Page 2: Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

PatientL. Q.78 y/o FemaleChief Complaint: Hematochezia

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Salient Features:Chief Complaint: Hematochezia

6 hours PTA- ½ teaspoon of blood after defecation4 hours PTA- 1 tablespoon of blood 30 mins PTA- 2 cupfuls of fresh blood

-Dizzy, cold clammy perspiration

Page 4: Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

Approach to the Patient: Lower Gastrointestinal

Bleeding

Measure the heart rate and blood pressure

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Approach to the Patient: Lower Gastrointestinal

Bleeding

Differentiation of upper from lower GIBHematemesis- indicates upper GI source of bleeding Hematochezia- usually represents lower GI source of

bleeding

Page 6: Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.

Approach to the Patient: Lower Gastrointestinal

Bleeding

Diagnostic Evaluation of the Patient with Lower GIB

Upper endoscopy– to rule out an

upper GI source before evaluation of lower GI tract

-Patients with hematochezia and hemodynamic instability

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Diagnostic Evaluation of the Patient with Lower GIB

Sigmoidoscopy for patients <40 years old with

minor bleeding for detection of obvious, low-

lying lesions risk of bleeding, area of

bleeding is usually not possible to identify

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Diagnostic Evaluation of the Patient with Lower GIB

Colonoscopy- procedure of choice

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Diagnostic Evaluation of the Patient with Lower GIB

Tc-labeled red cell scan-allows repeated imaging

for up to 24 hours - may identify the

general location of bleeding

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Diagnostic Evaluation of the Patient with Lower GIB

Angiography- can detect the site of bleeding - permits treatment with

intraarterial infusion of vasopressin or embolization

- may identify lesions with abnormal vasculature, such as tumors or vascular ectasias

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Figure 1.1 Suggested algorithm for patients with acute lower gastrointestinal bleeding

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Differential DiagnosisCommon causes of LGIB

DiverticulaVascular ectasia (Angiodysplasia)Neoplasms (Adenocarcinoma)