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.

Management

  • Triage and evaluate the patient on priority basis
  • Primary survey to find, is patient showing signs of haemodynamic compromise
  • 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

Investigations

  • Blood grouping and cross matching of 4 to 6 units
  • FBC, Urea and electrolytes,glucose,coagulation profile
  • ECG

Treatment

  • 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. Last review Dr ÍOS 13/12/21.