Antonio. Aramburo. Arcilla. Argana

Approach to a Patient with Lower GI Bleeding

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

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

Approach to the Patient: Lower Gastrointestinal

BleedingMeasure the heart rate and blood pressure

Approach to the Patient: Lower Gastrointestinal

BleedingDifferentiation of upper from lower GIB

Hematemesis- indicates upper GI source of bleeding Hematochezia- usually represents lower GI source of

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

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

Diagnostic Evaluation of the Patient with Lower GIB

Colonoscopy- procedure of choice

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

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

Figure 1.1 Suggested algorithm for patients with acute lower gastrointestinal bleeding

Differential DiagnosisCommon causes of LGIB

DiverticulaVascular ectasia (Angiodysplasia)Neoplasms (Adenocarcinoma)