Investigating IDA (BSG Guideline) And An overview of Obscure GI Bleed Dr.D.Ghosh

1. Investigating IDA (BSG Guideline) And An overview of Obscure GI Bleed Dr.D.Ghosh Gastroenterology Registrar

2. Anaemia: <10-11.5g/dl for women <12.5-13.8g/dl for men Not known at what level of Hb Ix should be initiated. No reason why mild anaemia should be less indicative of important disease than severe anaemia Iron deficiency: serum ferritin<12 MCV< 76 Transferrin sat<30% Bone marrow aspiration Therapeutic response Sr.transferrin receptor/ferritin ratio

3. Investigation History - dietary,drugs and family hx Examination-abd mass/cutaneous GI evaluation:all with confirmed IDA unless non GI blood loss Order of Ix in absence of symptoms-local availability OGD with small bowel bx : yield 30-50% Barium meal with coeliac serology if unable Colonoscopy:unless OGD positive for Ca or coeliac ALL pts should have lower GI ix Ba enema is a sufficent alternative with/without sigmoidoscopy (can omit in absence of lower GI symptoms and a normal PR Exam) FOB is of no benefit in the investigation of IDA –insensitive and nonspecific “The management of IDA is often suboptimal with most patients being incompletely investigated if at all”

5. Iron treatment • Different formulations • Vit c • Parental iron • Target: increase by 2 every 3wks • Replenish stores:3 more months • Monitor:3 monthly for a yr & then after one yr • Reassuring to know that IDA does not return in most pts in whom no cause is found after ix

6. Co-morbidity: appropriateness should be carefully considered and discussed with pts and carers. • Pre-menopausal women: • 5-10% incidence in that group • Hx unreliable to quantify • Ix only if>45yrs • Ogd & SI bx if upper GI symptoms • But coeliac serology in all • Lower GI ix only if symptoms,family hx,refractory after correction of potential cause • Post-gastrectomy:if refractory or occuring long after

9. Etiology of small-bowel bleeding

13. Classification of vascular malformations that cause gastrointestinal hemorrhage

14. Arteriovenous malformations in the gastrointestinal tract

15. Endoscopic views of small-bowel arteriovenous malformations

16. Endoscopic views of small-bowel arteriovenous malformations

17. Small-bowel arteriovenous malformations as the cause of gastrointestinal hemorrhage

18. Small-bowel tumors as the cause of gastrointestinal hemorrhage

19. Gastrointestinal hemorrhage of obscure origin arising from small-bowel tumors

21. Barium studies in the evaluation of small-bowel bleeding

22. Types of nuclear medicine studies for the evaluation of small-bowel bleeding

23. Diagnostic yield of nuclear medicine studies for small-bowel bleeding

24. Diagnostic value of Meckel's scan in the adult population

25. Arteriography in the diagnosis of small-bowel bleeding

26. Arteriography in gastrointestinal bleeding

27. Enteroscopy in the diagnosis and management of small-bowel hemorrhage

30. Yield of jejunoscopy for small-bowel bleeding

34. Treatment options for small-bowel bleeding lesions

35. Evaluation and management of acute hemorrhage

36. Evaluation and management of chronic gastrointestinal bleeding of obscure origin

37. Thank you