Lower GI bleed

background

Bleeding distal to ligament of Treitz.
One fifth to one third as common as upper GI bleed.
Most commonly = upper GI bleed presenting as lower GI bleed
Other causes include:
- Diverticulosis, Angiodysplasia, Haemorrhoids, Ischaemic colitis
- Polyp, inflammatory bowel disease, malignancy and aortoenteric fistula.

Triage and evaluate the patient on priority basis
Quick primary survey to find, is patient showing signs of haemodynamic compromise,such as pallor, sweating, tachycardia, hypotension, tachypnoea and impaired conscious level.
Resuscitate the patient using standard ABCD approach
Target oriented history,incl. PMHx of IBD, peptic ulcer, aortic surgery,etc.
Medications to note: NSAIDs,Steroids,and anticoagulants.
Record vita signs and perform cardiac, pulmonary, abdominal and rectal exam.

Maintain airway and provide high flow oxygen.
Attach ECG monitor & pulse oximeter.
Insert two large bore IV cannula in forearm veins(14G).
IV fluids (crystalloid)or blood according to haemodynamic response.
NG tube Urinary catheter.
CVP line if thermodynamically unstable.
Consult Surgical team on call.
If the source is upper GI then PPI (Losec)infusion at a rate of 8mg /hr is recommended.
Somatostatin should be considered in unwell patients with acute non variceal GI bleed who are likely to be bleeding from PUD, or where endoscopy is contraindicated or unavailable.[BestBets]

content by Mr Syed Ali Naqi Dr Íomhar O' Sullivan 28/05/2007. Next review 28/05/2008. Last review Dr ÍOS 5/05/15.