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 and fibrinogen levels
• 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]