Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.
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Transcript of Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.
![Page 1: Antonio. Aramburo. Arcilla. Argana Approach to a Patient with Lower GI Bleeding.](https://reader036.fdocuments.us/reader036/viewer/2022062409/5697c0021a28abf838cc34ba/html5/thumbnails/1.jpg)
Antonio. Aramburo. Arcilla. Argana
Approach to a Patient with Lower GI Bleeding
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PatientL. Q.78 y/o FemaleChief Complaint: Hematochezia
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Salient Features:Chief Complaint: Hematochezia
6 hours PTA- ½ teaspoon of blood after defecation4 hours PTA- 1 tablespoon of blood 30 mins PTA- 2 cupfuls of fresh blood
-Dizzy, cold clammy perspiration
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Approach to the Patient: Lower Gastrointestinal
Bleeding
Measure the heart rate and blood pressure
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Approach to the Patient: Lower Gastrointestinal
Bleeding
Differentiation of upper from lower GIBHematemesis- indicates upper GI source of bleeding Hematochezia- usually represents lower GI source of
bleeding
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Approach to the Patient: Lower Gastrointestinal
Bleeding
Diagnostic Evaluation of the Patient with Lower GIB
Upper endoscopy– to rule out an
upper GI source before evaluation of lower GI tract
-Patients with hematochezia and hemodynamic instability
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Diagnostic Evaluation of the Patient with Lower GIB
Sigmoidoscopy for patients <40 years old with
minor bleeding for detection of obvious, low-
lying lesions risk of bleeding, area of
bleeding is usually not possible to identify
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Diagnostic Evaluation of the Patient with Lower GIB
Colonoscopy- procedure of choice
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Diagnostic Evaluation of the Patient with Lower GIB
Tc-labeled red cell scan-allows repeated imaging
for up to 24 hours - may identify the
general location of bleeding
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Diagnostic Evaluation of the Patient with Lower GIB
Angiography- can detect the site of bleeding - permits treatment with
intraarterial infusion of vasopressin or embolization
- may identify lesions with abnormal vasculature, such as tumors or vascular ectasias
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Figure 1.1 Suggested algorithm for patients with acute lower gastrointestinal bleeding
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Differential DiagnosisCommon causes of LGIB
DiverticulaVascular ectasia (Angiodysplasia)Neoplasms (Adenocarcinoma)