This document discusses lower gastrointestinal (GI) bleeding, which is less common than upper GI bleeding but increases with age. Lower GI bleeding originates below the ligament of Treitz and is usually from the colon. Diagnosis involves examining the patient for signs of bleeding and localizing the source through tests like colonoscopy and tagged red blood cell scans. Treatment depends on the identified lesion but may include surgery if bleeding is severe or the site cannot be localized. Diverticular disease, which can cause lower GI bleeding, is also discussed, along with its pathogenesis, types (diverticulosis vs. diverticulitis), and treatments.

1. LOWER GI BLEEDING
Shikur E

10. LOWWER GI BLEEDING
• LESS COMMEN (20%),incidence increase with
age
• BELOW LIGAMENT OF TREITZ
• 95 % from colon
• The bleeding is less severe , intermittent and
stops spontaneously than upper GI bleeding

12. DX
• Pt typically present with hematochazia,but
Melina can also be from LGI bleeding( SLOW
TRANZAINT TIME)
• LGI bleeding are difficult to dx than upper GI
bleeding AND up to 40 % has more than one
possible cause of bleeding
• IN 25 % of pt bleeding are obscure despite
possible investigation

13. • Once initiate resuscitation try to localize site of
bleeding
.perianal cause like hemorrhoid, anal fissure
do DRE,Anoscopy
.with significant bleeding exclude UGI
BLEEDING(NG TUBE aspirate or EGD)
.colonoscopy
.Tagged RBC scan
.angiography

16. TREATMENT
• Therapeutic approaches with lower GI
bleeding are clearly dependent on the lesion
identified.
• The criteria for surgery are similar to those for
upper GI hemorrhage, although there is a
stronger tendency to delay until the site is
clearly localized.

18. DIVERTICULAR DISEASE
• Is a clinical term used to describe the
presence of symptomatic diverticula
• Diverticulosis vs diverticulitis
• Can occur from esophagus to rectosigmoid
junction, but never involve rectum
• Sigmoid colon is commonest site
• Classified as acquired( majority) and
congenital(true diverticula)

20. PATHOGENESIS
• EXACT COUSE NOT KNOWN
• Lack of fiber diet =>small stool
volume=>increased intraluminal
pressure=>segmentation of bowl
musculature=>acquired diverticula

21. diverticulitis
• Inflammation and infection associated with
diverticula
• Occur in 10 to 25% of diverticulosis
• Result from either macroscopic or microscopic
perforation of the diverticula
• Uncomplicated vs complicated diverticulitis

22. C/F
• Most diverticulitlosis are asymptomatic
• Diverticulitis ;left lower quadrant pain
,tenderness,fever,lecosytosis and/or LLQ
mass,obstractive symptom

23. Uncomplicated diverticulitis
• CT:-PERICOLIC soft tissue stranding ,colonic
wall thicking,&/or phlegmon
• Most pt can be treated with oral antibiotic for
7 to 10 day,10 to 20 % by iv antibiotic
• Most pt improved with in 48 to 72 hr,if not
consider complicated diverticulitis

24. • Surgery may be required for uncomplicated
diverticulitis in case of:-
.recurrent diverticulitis??????
.imunocompromised pt

25. Complicated diverticulitis
• Include diverticulits with
abscess,obstraction,difuse peritonities,or fistula
• Hinchey staging system of colonic complicated
diverticulitis:-are diverticulitis with;
.stage I PERICOLIC ABCESS
.stage II retroperitonial or pelvic abscess
.stage III purulent peritonitis
.stage iv fecal peritonitis

26. • Treatment depend on stage
.iv antibiotics for small abscess(<2 cm)
+resection
.drainage(percutaneous,laparascopic or
open) +resection
.emergent laparatomy +resection for
peritonitis

27. Hemorrage from diverticula
• Result from erosion of peridiverticular arteriols
• Occur in 3 to 15% of diverticula
• Bleeding is more common in the rt side
diverticula
• Most pt present with chronic bleeding, but in
15% massive bleeding may occur
• In 80% of pt bleeding stops spontaneously
• Dx;colonoscopy,angiography

28. TREATMENT
• RESUSCITATION
• In acutely bleeding pt:-
.intra-arterial vasopressin
.embolization
.endoscopic electrocoagulation
.injection with sclerosing agent
.if the above measures fails or bleeding recur ,and if
the site is localized =>surgery(segmental resection)
is recommended

29. ANY
COMMENT
OR
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