GI - Lower GI Bleeding

Question 1

Name the most common/important causes of lower GI bleed and other, less important/common ones

Answer 1

• Rectal (haemorrhoids/fissure), diverticulitis, neoplasm
• Other: inflammation (IBD), infection (shigella, campy, c diff), polyps, larger upper GI bleed, angio (dysplasia, ischaemic colitis, and HHT [hereditary haemorrhage telangiectasia])

Question 2

Ix: bloods and stool

Answer 2

• Bloods: FBC, U&E, LFT, X match, clotting, amylase

- Stool: MCS test (blue stool bottle)

Question 3

Ix: imaging

Answer 3

• AXR, eCXR
• Angiography: necessary if source not found on endoscopy
• Red cell scan

Question 4

Ix: endoscopy

Answer 4

• Rigid proctoscopy/sigmoidoscopy
• OGD
• Colonoscopy: difficult in major bleeding

Question 5

Mx:

Answer 5

• ABCDE approach
• IV fluid resus
• Urinary catheter
• ABX: if evidence of sepsis or perforation
• PPI: if upper GI bleed suspected/possible
• Keep bed bound: need to pass stool may lead to a large bleed and a collapse, best to be in bed when it happens
• Stool chart + I/O
• Diet: keep on clear fluids (allows colonoscopy)
• Surgery: only if unremitting, massive bleed

Question 6

Angiodysplasia: what is it?

Answer 6

• Degenerative lesion, acquired, probably resulting from chronic and intermittent contraction of the colon that obstructs venous drainage of mucosa.
• With time: veins become more and more tortuous, while the capillaries of the mucosa gradually dilate and precapillary sphincter becomes incompetent.
• T/f get formation of AV malformation characterized by a small tuft of dilated vessels.
• Most common is caecum and ascending colon

Question 7

Angiodysplasia: presentation

Answer 7

• Elderly patients
• Fresh PR bleeding
• Some pts can have melena while others only have an anaemia
• faecal occult screening may not pick it up if disease not active at the time

Question 8

Angiodysplasia: Ix

Answer 8

• Exclude other Dx with PR exam, BA enema, colonoscopy, mesenteric angiography or CT angiography
• Tc-labelled RBC scan: identify active bleeding

Question 9

Angiodysplasia: Rx

Answer 9

• Embolisation
• Endoscopic laser electrocoagulation
• Resection