Antonio. Aramburo. Arcilla. Argana
Approach to a Patient with Lower GI Bleeding
PatientL. Q.78 y/o FemaleChief Complaint: Hematochezia
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
Approach to the Patient: Lower Gastrointestinal
BleedingMeasure the heart rate and blood pressure
Approach to the Patient: Lower Gastrointestinal
BleedingDifferentiation of upper from lower GIB
Hematemesis- indicates upper GI source of bleeding Hematochezia- usually represents lower GI source of
bleeding
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
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
Diagnostic Evaluation of the Patient with Lower GIB
Colonoscopy- procedure of choice
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
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
Figure 1.1 Suggested algorithm for patients with acute lower gastrointestinal bleeding
Differential DiagnosisCommon causes of LGIB
DiverticulaVascular ectasia (Angiodysplasia)Neoplasms (Adenocarcinoma)