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LOWER G.I. BLEEDING

LOWER G.I. BLEEDING. DR. JAMAL HAMDI. Upper G.I. Bleeding True Lower G.I. Bleeding. Massive G.I. Bleeding. Diverticular disease Vascular ectasia. Causes of bleeding per rectum. Cancer & Polyps Common Anorectal diseases Ischemic & Infectious Colitis Inflammatory bowel diseases

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LOWER G.I. BLEEDING

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  1. LOWER G.I. BLEEDING DR. JAMAL HAMDI

  2. Upper G.I. Bleeding True Lower G.I. Bleeding

  3. Massive G.I. Bleeding • Diverticular disease • Vascular ectasia

  4. Causes of bleeding per rectum • Cancer & Polyps • Common Anorectal diseases • Ischemic & Infectious Colitis • Inflammatory bowel diseases • Meckel’s diverticulum

  5. Proctoscopy + sigmoidscopy History + Examination No Blood Lower G.I. Bleeding Nasogastric aspiration Laboratory Blood

  6. Anorectal Pathology Proctoscopy + Sigmoidscopy No Anorectal Pathology RBC Scan

  7. Positive Angiography RBC Scan Colonoscopy Negative

  8. Site localized Vasopressin infusion Angiography Site not localized Segmental resection

  9. Observe Bleeding stop or Segmental resection Vasopressin infusion Bleeding continue Segmental resection

  10. Lesion found Segmental resection Colonoscopy Lesion not found Total Colectomy ?

  11. Tagged Red blood cell Scan 30-60 minutes preparation 2 hours duration Detect > 0.5 ml/min Useful in intermittent bleeding

  12. Sulfur Colloid Scan 20 minutes duration Detect > 0.1 ml/min Cleared by Liver and spleen

  13. Angiography Detect 0.5 – 1.0 ml/min Identify exact vessel May identify lesion Therapeutic a) Vasopressin b) Embolisation

  14. Emergency Surgery if • Patient needed > 6 units Blood / 24 hours • Continue bleeding after vasopressin or embolisation Thank you …

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