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History taking and physical examination for lower gastro intestinal bleed
 

History taking and physical examination for lower gastro intestinal bleed

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    History taking and physical examination for lower gastro intestinal bleed History taking and physical examination for lower gastro intestinal bleed Presentation Transcript

    • HISTORY TAKING AND PHYSICALEXAMINATION FOR LOWER GI BLEED
    • HISTORY TAKINGOnset acute-ischaemia,meckel’s diverticulum,angiodysplasia Chronic-piles,IBD,Ca,polyps PILES
    • AGE < 50 yrs- infection, anorectal disease, IBD > 50 yrs- malignancy, diverticulosis Any age- pilesDIVERTICULOSIS
    • PAIN Painful-anorectal lesions, Ca anal canal, piles Painless- polyps, Meckel’s diverticulumPAIN IN RELATION TO DEFEACATION On defeacation- piles, Ca anal canal After defeacation- solitary rectal ulcer POLYPS
    • TENESMUS rectal Ca, ulcerative proctitis, irradiation proctitisABDOMINAL PAIN AND BLOODY DIARRHEA IBD, infectious diarrhea, Ca colon
    • NATURE OF BLOOD AND STOOLS Anorectal bleeding- straining and passing of hard stools, with dripping of blood Piles- blood may splash or drip after defeacation Ca anal canal and rectum- streaking of blood on stools MALIGNANCY
    • COLOR OF STOOLS Brown stools streaked with blood- rectosigmoid or anal cause Large volume of bright red blood- colonic source Black stools- upper GI bleed Maroon stools- small intestine or right colon Bright red blood- anal canal
    •  Bleeding from other sites- indicates systemic disease/ drug induced bleeding Weight loss, anorexia, abdominal pain, vomitting – malignancy Sexual abuse- trauma to anal canal
    • PAST HISTORY Radiation Heart disease- mesenteric embolism Drugs- warfarin, heparin, NSAIDs Liver disease- variceal bleeding Chronic renal failure
    • FAMILY HISTORY Carcinoma
    • PERSONAL HISTORY Smoking- peptic ulceration, colorectal Ca alcohol
    • CLINICAL EVALUATION history and physical examination are not usually diagnostic of the source of GI bleed Examine all system in detail with special reference to per rectum examination
    • Patients with massive LGIB usually present with bright red blood per rectum hypotension markedly reduced hematocrit
    • Patients with mild bleeding who may present with intermittent passage of maroon-colored stools.
    • DIFFERENTIAL DIAGNOSISColonic bleeding( % Small bowel95%) bleeding(5%)Diverticular ds 30-40 Angiodysplasiaischaemia 5-10 UlcerAnorectal ds 5-15 Radiationneoplasia 5-10 neoplasiapolyp 3-7IBD 3-4angiodysplasia 3
    • THANK YOU