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Lower GI Bleeding

Lower GI Bleeding. Dr. M. Ghanem. A less common reason for hospitalization 95%  from the colon Etiology usually age related. Presentation. Hematochezia (bright red blood, clots) May present with melena Usually less severe than UGI. Etiology. Diagnosis. Diagnosis. Colonoscopy.

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Lower GI Bleeding

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  1. Lower GI Bleeding Dr. M. Ghanem

  2. A less common reason for hospitalization • 95%  from the colon • Etiology usually age related

  3. Presentation • Hematochezia (bright red blood, clots) • May present with melena • Usually less severe than UGI

  4. Etiology

  5. Diagnosis

  6. Diagnosis

  7. Colonoscopy • Major bleeding interferes significantly with visualisation • Successful in identifying the source of bleeding in up to 95% of cases

  8. Radionuclide Scanning • Most sensitive study • Least accurate for localization of bleeding • RBCs from the ptn r labeled with Tc99 and reinjected, images are collected • Detect bleeding at a rate of 0.1cc/min • Lack spatial resolution • As a guide to the utility of angio

  9. Angiography • Detect hemorrhage at a rate of 0.5-1 cc/min • Therapeutic advantage (vasopressin inj., embolization) • Invasive • Complications include: • Hematoma • Areterial thrombosis • Contrast rxns • ARF

  10. Video Capsule • A video camera is swallowed • Identifies the source of bleeding is 90% of cases • Good in stable ptns • Doesn’t have a treatment option

  11. Push enteroscopy • Can reach 70 cms from the ligament of treitz • Successful in 40% of cases • Video capsule is usually preferred

  12. Diveticulosis • The most common cause of LGIB (55%) • >75% stop bleeding spontanously • 10% rebleed within 1 year • 50% rebleed within 10 years • >50% of bleeds from Rt colon

  13. Diveticulosis • Diagnosis by colonscopy • Tx by injecting epinephrine, cautery of clip with colonscopy • Angio carries risk of ischemia

  14. Angiodysplasia • About 40% of LGIB • Acquired degenerative lesions secondary to progressive dilation of normal blood vessels within the submucosa of the intestine • Can occur anywhere in the bowel, cecum most common site • Diagnosis by colonoscopy, angio • Appear as red stellate lesions with a rim of pale mucosa

  15. Angiodysplasia • Tx with sclerotherapy or cautery (colonscopy), embolization by angio • Rebleeding consider surgery

  16. Neoplasia • Uncommon cause of significant LGIB • The first to rule out!!! • Polyps • Diagnosis by colonscopy • Tx depends whether it’s a tumor or polyp, pathology, etc…

  17. Anorectal Disease • Include internal hemorrhoids, fissures and colorectal neoplasia • 5-10% of LGIB • Bright-red blood per rectum that is seen in the toilet bowl and on the toilet paper • Internal hemorrhoids: painless, a lump that reduces spontanously or by ptn • Fissures: painful

  18. Anorectal Disease • Malignancy needs to be ruled out before assuming that the bleeding is due to hemorrhoids • Tx of hemorrhoids: rubber band ligation, sclerotherapy, coagulatiom, surgery • Tx of fissures: stool softeners, NG, Ca channel blockers

  19. MeckelsDiverticulum • A true diverticulum • Remnant of the omphalomesentric duct • Caused by acid production by ectopic musocsa • Diagnosis by nuclear imaging, angio • Tx is surgical

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