Lower GI Bleeding

Question 1

Description: AAA

Answer 1

AAA

Question 2

Aetiology/ Risk Factors: What are the colonic causes of acute lower GI bleeding?

Answer 2

Causes:

• Diverticular disease (presence of small out-pouching known as diverticulae in the mucosa of the small intestine)
• Haemorrhoids (Enlarged vascular cushions around anal canal)
• Ischaemic colitis
• Radiation enteropathy
• Neoplasia (carcinoma or polyps)
• Vascular malformations
• Inflammatory bowel disease

Question 3

Pathology: XXX

Answer 3

XXX

Question 4

Symptoms and Signs: How does a person with acute lower GI bleeding present? (3)

Answer 4

• Fresh blood being passed
• Magenta coloured stools
• Painless (typically)

Question 5

Investigations: How do investigate a lower GI bleed with

a) Colonic origin (2
(b) Small bowel origin (4)

Answer 5

(a) Colonic origin
- Colonoscopy
- CT angiogram (locates the site of bleeding)

(b) Small bowel origin
Small bowel investigations (because no colonic cause):
- CT angiogram
- Meckel’s scan (Scintigraphy)
- Capsule endoscopy
- Double balloon enteroscopy

Question 6

Treatment: How do we treat a patient with lower GI bleeding?

Answer 6

Management of lower GI bleeding requires PROMPT RESUSITATION:
- Protect the AIRWAY

• Give high flow O2 to help with BREATHING
• To ensure adequate CIRCULATION, gain IV access to give IV fluids. Using an IV cannula, take bloods (FBC, U+E, LFTs, coagulation) and cross match before doing a blood transfusion (if Hb<70g/L). Insert a urinary catheter. Tranexamic acid to inhibit clot breakdown.
• DISABILITY
• EXPOSURE
• Urgent ENDOSCOPY once stable
• Correct clotting abnormalities by giving VITAMIN K
• IV platelets or FFP if ongoing bleeding

Question 7

Complicaitons: AAA

Answer 7

AAA

Question 8

Extra: XXX

Answer 8

XXX