Surgery 6th year, Tutorial (Dr. AbdulWahid)

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Dec. 21st, 2011

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  • Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
  • Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
  • Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
  • Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
  • Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
  • Surgery 6th year, Tutorial (Dr. AbdulWahid)

    1. 1. Lower GI Hemorrhage ABDWAHID M SALIS, M.D
    2. 2. LGI hemorrhage Colon – 95-97% Small bowel – 3-5% Only 15% of massive GI bleeding Finding the site Intermittent bleeding common  Up to 42% have multiple sites
    3. 3. Hematochezia: Bright red stool, called, is the sign of a fast moving active GI bleed Maroon color: short time taken from the site of the bleed and the exiting at the anus
    4. 4. Causes Coagulopathy - specifically a bleeding diathesis
    5. 5. Bleeding diverticulosis Colonic angiodysplasia
    6. 6. Diverticulosis – 40-55% 90% stop spontaneously 10% rebleed in 1st year and 25% at 4 years
    7. 7. Angiodysplasia – 3-20% – >50 y/o –>50% are in right colon argon plasma coagulation
    8. 8. Neoplasia –Typically bleed slowly –Polyps
    9. 9. Inflammatory conditions 15% of UC patients, 1% of chron’s patients Ischaemic Radiation Infectious AIDS rarely
    10. 10. Hemorrhoids –>50% have hemorrhoids, – but only 2% of bleeding attributed to them
    11. 11. Meckels Diverticulum  The most common cause of massive bleeding in pediatric patients
    12. 12. Evaluation Same for UGI bleed If unstable with hematochezia need EGD 1st
    13. 13. Concealed Bleeding Occasionally, a person with a LGIB will not present with any signs of internal bleeding.  A Diagnostic or pre-assessment: hypotension, tachycardia, angina, syncope, weakness, confusion, stroke, myocardial infarction/heart attack, and shock.
    14. 14. Laboratory test  Hemoglobin, hematocrit, and platelets  Partial thromboplastin time (PTT) and INR
    15. 15. Diagnostics Colonoscopy Video capsule endoscopy Intraoperative endoscopy
    16. 16. Selective viseral angiography Need >0.5 ml/min bleeding 40-75% sensitive if bleeding at time of exam
    17. 17. Tagged RBC scan Can detect bleeding at 0.1 ml/min
    18. 18. Meckel’s scan Initial test for patients <30 years old
    19. 19. Enteroclysis Ulcerations Inflammation
    20. 20. CT scan Tumors  Inflammation  Diverticuli
    21. 21. GI hemorrhage from unknown source Only 2-5% are not upper or lower
    22. 22. Treatment Endoscopy: Theraputic Angiodysplasia polypectomy sites
    23. 23. Angiographic – Selective embolization for poor surgical candidates – Can lead to ischemic sites requiring later resection
    24. 24. Surgery Ongoing hemorrhage, >6 units ongoing transfusion requirement Site selection Intraoperative endoscopy Segmental resection
    25. 25. ‫ل‬ ‫الحمد‬

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