Lower GI bleeding

Question 1

What are the causes of lower GI bleeding?

Answer 1

• erosive or inflammatory
• vascular
• tumors -> colorectal/anal cancer & colonic polyps
• anal fissures
• trauma

Question 2

What are the erosive/inflammatory causes of lower GI bleeding?

Answer 2

• diverticulosis
• inflammatory bowel disease
• invasive or inflammatory diarrhea (Shigella)

Question 3

What are the vascular causes of lower GI bleeding?

Answer 3

• hemorrhoids
• ischemia
• arteriovenous malformation -> angiodysplasia (right side colon)
• rectal varices

Question 4

What are the traumatic causes of lower GI bleeding?

Answer 4

• lower abdominal trauma
• anorectal trauma (anorectal avulsion, impalement injuries
• during or after surgery or endoscopic procedure

Question 5

What are the clinical features of lower GI bleeding?

Answer 5

• anemia due to chronic blood loss

- acute hemorrhage -> hypovolemic shock

Question 6

How should a patient with lower GI bleeding be managed?

Answer 6

• all patients -> 2 large-bore peripheral IVs
• stable -> restrictive transfusion strategy
• unstable -> ABCDE

Question 7

What are the investigations used to diagnose lower GI bleeding?

Answer 7

• COLONONSCOPY gold standard -> high risk patients
  - > history of polyps IBD
  - > multiple episodes of massive bleeding
• endoscopy -> identify source of bleeding
• proctosigmoidoscopy -> in mild bleeding
  - > low risk patients
  - > in anal canal conditions

Question 8

What are the indications of angiography?

Answer 8

• GI bleeding & hemodynamically instability
• patients with rebreeding or ongoing bleeding despite endoscopic hemostasis
• angioembolization
• intraarterial vasopressin

Question 9

What are the indications for surgery in lower GI bleeding?

Answer 9

• if other therapies failed
• diverticulosis
• IBD
• colorectal carcinoma
• polyps
• hemorrhoidal bleeding
• angiodysplasias

Question 10

When is capsule endoscopy used?

Answer 10

in obscure GI bleeding usually from the small bowel

- balloon enteroscopy is therapeutic