Lower GI bleeding accounts for 24% of GI bleeding and usually presents with melena or hematochezia. It is typically less severe than upper GI bleeding, with a mortality rate of 2-3.6%. Common causes in patients under 50 include inflammatory bowel disease and anorectal diseases like hemorrhoids, while those over 50 often experience bleeding from diverticulosis, angiodysplasias, or neoplasms. Diagnostic evaluations include rectal exam, endoscopy, technetium scan, angiography, and colonoscopy. Initial management focuses on ABCs, IV fluids, and identifying the source and severity of bleeding.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
There are 2 reasons for which patients come to Mayo Hospital:
1. Someone in the periphery tells them,that Mayo is the only place where they'll find best facilities and "Multidisciplinary Management" by which they are able to cure incurables.
2. They don't have money to afford any other hospital.
I'm not exaggerating but we really try to live up to these expectation. Case below is a classical example of that. This Patient had been managed by 3 hospitals,and for 11month he was living his days waiting for his death due to a benign disease. Alhamdulillah Dr Haroon Rafi Ul Islam and his team successfully managed the case,and this orphan,only child of a widow,is doing perfectly well. We are thankful to our Gastroenterology Department, Radiology Department for helping us reach the diagnosis, Our House Officers for bringing this Patient to us and donating their own blood for him. We especially want to thank SPWS for arranging blood donations for this Patient. God bless you all.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
There are 2 reasons for which patients come to Mayo Hospital:
1. Someone in the periphery tells them,that Mayo is the only place where they'll find best facilities and "Multidisciplinary Management" by which they are able to cure incurables.
2. They don't have money to afford any other hospital.
I'm not exaggerating but we really try to live up to these expectation. Case below is a classical example of that. This Patient had been managed by 3 hospitals,and for 11month he was living his days waiting for his death due to a benign disease. Alhamdulillah Dr Haroon Rafi Ul Islam and his team successfully managed the case,and this orphan,only child of a widow,is doing perfectly well. We are thankful to our Gastroenterology Department, Radiology Department for helping us reach the diagnosis, Our House Officers for bringing this Patient to us and donating their own blood for him. We especially want to thank SPWS for arranging blood donations for this Patient. God bless you all.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2. G.I.BLEEDING DEFINITIONS
Acute versus chronic
Upper (proximal to ligament of treitz)
Lower(distal to ligament of treitz)
Overt-clinical signs/symptoms present
Occult-not clinically evident(FOBT + or iron
def anemia)
Obscure-routine evaluation
3. INTRODUCTION
Bleeding arising below the Ligament Of Treitz
Either from the small intestine or from the
colon
Majority of the cases arise from colon
specially the ANORECTAL region
5. LOWER GI BLEED
Accounts for 24% of all GI bleeding
Presentation can be malena(19%)or
hematochezia(81%)
Usually less severe than upper GI bleeding
Mortality of 2-3.6%
6. TYPES
(Depending upon patients age)
PATIENTS BELOW
50years OF AGE
Inflammatory bowel
diseases
Infectious colitis due to
Shigella,E.coli
Anorectal diseases like
Hemorrhoids, Anal
fissures
PATIENTS ABOVE
50years OF AGE
Diverticulosis
Angiodysplasias
Neoplasms
Ischemic colitis
7. TYPES BASED ON BLEEDING
BLEEDING WITH
PAIN
Anal fissures
Ischemic colitis
Inflammatory bowel
diseases
PAINLESS
BLEEDING
Internal hemorrhoids
Diverticulosis
Angiodysplasias
8. EPIDEMIOLOGY
Mortality is usually due to co-morbid
conditions(like organ
failure,AMI,aspiration,sepsis)
Bleeding stops spontaneously>80% of the
time.
13. ANORECTAL DISEASE
Hemorrhoids present as painless bleeding mixed
with stool or dipping into toilet bowl
Painless small bleeding can occur in case of
small fissure
14. ISCHEMIC COLITIS
Seen in elderly especially those who have
atherosclerosis presenting as bloody diarrhea
with mild abdominal pain
18. ANGIOGRAPHY
In active bleeding it is the investigation of choice
Selective angiography indicated for massive ongoing
lower G.I bleeding or with recurrent bleeding and
negative colonoscopy.
Can detect rates of 0.5ml/min
Can be used as therapy-coil
embolization,alcohols,vasoconstrictors.
70-100%effective if positive
Low rebleeding rate-12%
19. COLONOSCOPY
Performed if bleeding stops or occurs at slow
rate
Allows identification of angiodysplasia,tissue
biopsy and therapeutic intervention with
electrocautery heater probe or laser therapy of
active bleeding
Not helpful during massive bleeding
20. ASSESMENT
Includes history and examination
Age
Attention to vitals, volume status, oxygen
saturation, urine output
Evidence of liver disease
Risk factors, use of
NSAIDs,anticoagulation,co-morbidities,
21. LABORATORY ASSESMENT
Complete blood count
Blood type and cross-match
Coagulation factors PT,APTT
Chemistry panel
BUN/Cr ratio
Bilirubin,albumin,INR to asses for hepatic
synthetic dysfunctions
23. MANAGEMENT
If the patient has massive ongoing bleeding with
homodynamic instability, urgent angiography
is indicated
If colonoscopy does not reveal a source, but
bleeding continues-tagged RBC scan should
be done to localize bleeding
If colonoscopy doesn't reveal a source,but
bleeding stops, observe patient.
24. SURGERY
Done on patients who have failed
medical,colonoscopic,angiographic
intervention
Ongoing bleeding>4U of PRBC per 24h
Effort should be made to localize the source
prior to surgery.
26. OCCULT LOWER GI BLEED
Loss of small blood that can not be seen
Detected in 2 settings
FOBT +
Iron def anemia
27. CONCLUSION
Always remember to treat the patient
Resuscitate-ABC
Correct coagulopathy
Patient die from co-morbidities
Gi bleeding requires a multidisciplinary
approach-critical care,medicine,G.I radiology
and surgery.