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Pr bleeding

Pr bleeding. By Helen Bermingham. Mesenteric blood vessels. Coeliac trunk T12 foregut left gastric common heptic splenic SMA L1 midgut inferiorpancreaticoduodenal middle colic right colic intestinal ileocolic IMA L3 hind gut left colic sigmoid superior rectal. HISTORY.

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Pr bleeding

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  1. Pr bleeding By Helen Bermingham

  2. Mesenteric blood vessels Coeliac trunk T12 foregut left gastric common heptic splenic SMA L1 midgut inferiorpancreaticoduodenal middle colic right colic intestinal ileocolic IMA L3 hind gut left colic sigmoid superior rectal

  3. HISTORY • Colour of blood eg. Bright red • Mixed in with stools or coating stools • How long its been happening for • Pain • Abdominal pain • Red flag symptoms eg weight loss, anorexia, change in bowel habit, • Family hx • Anticoagulation • Recent colonscopy/polypectomy

  4. Examination • Does the patient look well or unwell? • Observations • Hands/eyes/mouth/lymph nodes • Abdomen • Look • Palpate • Percuss • Listen • pr

  5. Unwell patient • 0xygen • 2x large bore iv access and bloods • Fluid challenge • Correct warfarin and stop anticoagulants • Tranexamic acid 1g • Catheter • Call senior doctor

  6. Well patient • Iv access and bloods • AXR, ERECT CXR • Correct warfarin and stop anticoagulants • Endoscopy • Ogd • Flexi sigmiodoscopy • colonoscopy

  7. management • Ct angiogram • Mesenteric angiogram with embollisation • surgery

  8. Causes of pr bleeding • DIVERTICULTITS 20-55% • ISCHAEMIC COLITIS 20% • CANCER 10-15% • ANGIODYSPLASIA 10% • ANORECTAL DISEASE 5-10% • POST POLYPECTOMY 5% • SMALL BOWEL PATHOLOGY • ANGIODYSPLASIA,LYMPHOMA,ULCERS,CROHNS

  9. Diverticular disease • Definition • Formation of outpouches of colonic mucosa extruding through the muscular wall of the bowel • Pathogensis • High intraluminal pressure, low fibre diet • Potential Areas of weak colonic wall, vessels

  10. Complications • Infection • Fistula formation • Abscess formation • haemorrhage • perforation

  11. Ischaemic colitis • Definition • acute vascular insufficiency of the colon • Pathogensis • Thromboembolic Arterial occlusion • Venous occlusion • Systemic vasculitis • Arthrosclerosis and cardiovascular disease • Secondary to intestinal obstruction • Strangulated hernia • Intussusception • Volvulus • Patients complain of • Abdominal pain • Bloody diarrhoea • Usually elderly patients • Usually settles • Flexi sig/colonoscopy • 15% develop gangrene- high risk of death

  12. Colorectal cancer • 4th most common cancer in the uk • Approx 40,000 cases a year • Lifetime risk 1in 14 in men, 1 in 19 in women.

  13. Colorectal cancer

  14. Colorectal cancer • Risk factors • Genetic • Pre existing polyps • Inherited bowel cancer syndromes • Familial adenomatous polyposis (fap) • Hereditary non polyposis colon cancer (hnpcc) • Environmental • Inflammatory bowel disease

  15. Colorectal cancer • 37% rectum • 27% sigmoid • 14% caecum • 7% ascending • 3% hepatic flexure • 3% splenic flexure • 5% cases synchronous

  16. Colorectal cancer • Symptoms • Anaemia • Change in bowel habit • Weight loss • Pr bleeding/perforation/fistula • Obstruction • Colonscopy • Biopsy • Staging ct/mri

  17. Angiodysplasia • Definition • Small vessel malformation in the colon • More common in the elderly, related to degeneration of the blood vessels • More common on the right side of the bowel • Colonoscopy/angiography • Colonoscopic electrocoagulation • Embolisation • Surgical resection

  18. haemorrhoids • Definition • Small blood filled swellings caused by dilated varicose veins • Predisposing factors • constipation • Age • Pregnancy • Hereditary factors

  19. haemorrhoids

  20. Haemorrhoids treatment • Topical ointments • Banding • Sclerotherapy • surgery

  21. Anal fissure • Definition • Tear or ulcer in the lining of the anal canal • Constipation • Treatment • Laxatives • gtN/diltiazem cream • Botox • surgery

  22. Inflammatory bowel disease • Crohns • Skip lesions • Anywhere along the gi tract • transmural • Ulcerative colitis • Continuous ulcer • Only large bowel • Mucosa only

  23. SUMMARY • COMMON 50% PEOPLE/YEAr • SELF LIMTING • Reported 2-4%

  24. Any questions?

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