for download go to Etiology of lower gastrointestinal bleeding ppt, gastrointestinal bleeding ppt, History takingin lower gastrointestinal bleeding ppt, Investigations in lower gastrointestinal bleeding ppt

1. LOWER GI BLEED

2. ROUTINE INVESTIGATIONS
 BLOOD ROUTINE
-Hb
-PCV
-ESR
• URINE ROUTINE
 STOOL EXAMINATION

3. SPECIAL INVESTIGATIONS
 SIGMOIDOSCOPY
 COLONOSCOPY
 VIDEO CAPSULE ENTEROSCOPY
 Tc-RBC SCAN
 ANGIOGRAPHY

4. SIGMOIDOSCOPY & COLONOSCOPY
 60 cm flexible colonoscope following bowel
preparation
 Combined with proctoscopy:
-detectn of haemorrhoids,ulcerative
col.
- colorectal neoplasms
-angiodysplasia,bowel ischaemia

5. FLEXIBLE
SIGMOIDOSCOPE

8. C/I
-s/v active ulcerative colitis
-s/v shock
COMPLICATIONS
-perforation
-bleeding following polypectomy

9. VIDEO CAPSULE ENDOSCOPY
 employs a 26mm capsule with an
imaging device, battery, transmitter &
antennae.
 Transmits images as it traverses to a
battery powered recorder worn on a belt
around the waist.
 Capsule excreted after 8hrs
 Images analysed as video sequence &
lesions localised.

10. VIDEO CAPSULE

13. C/I
-known or suspected bowel stricture
-caution in pts with pacemaker
COMPLICATIONS
-capsule retention

14. DOUBLE BALLOON ENDOSCOPY

15. Long endoscope with a flexible tube
Sequential,repeated inflation &
deflation of balloon pushes & pulls the
endoscope along the entire length of
SI to the terminal ileum.
Diagnose & treat small bowel lesions.

17. C/I
-perforation
-shock
COMPLICATIONS
-post procedure abdominal pain
-pancreatitis

18. ANGIOGRAPHY

19. Tc PERTECHNATE SCAN
Diagnosis of MECKEL’S
DIVERTICULUM in obscure GI
bleeding.
Isotope injected i.v. and localises in
ectopic parietal mucosa with
diverticulum.

21. ACUTE LOWER GI BLEED
NO HEMODYN.
HEMODYN. INSTABILITY
INSTABILITY
<40yrs >40yrs
FLEXIBLE COLONOSCOPY
SIGMOIDOSCOPY

22. HAEMODYNAMIC INSTABILITY
Bleed’g Mild-mod s/v bleed’g
stops bleed’g persists persists
Consider enteroscopy angiography/
enteroscopy, Tc RBC scan/ Tc-RBC scan
video capsl, angiography
Angiography video capsule enteroscopy
If major bld
loss intraoperative intraoperative
endoscopy endoscopy