1. GI bleeding can be classified as upper GI bleeding (proximal to the ligament of Treitz) or lower GI bleeding (distal to the ligament of Treitz).
2. The document outlines the emergency resuscitation, history taking, examination, risk stratification, causes, management, and prognosis of GI bleeding.
3. Key aspects of management include fluid resuscitation, endoscopy, pharmacotherapy such as PPIs, and surgery if bleeding persists despite other treatments. Outcomes depend on severity of underlying conditions.
G I bleeding with radiological interventions(ACR Appropriateness Criteria).Tc-99m RBC scintigraphy,Catheter-directed Angiography,Pharmacological control,Embolization,Arterial interventions,Endoscopy,CT Angiography
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
G I bleeding with radiological interventions(ACR Appropriateness Criteria).Tc-99m RBC scintigraphy,Catheter-directed Angiography,Pharmacological control,Embolization,Arterial interventions,Endoscopy,CT Angiography
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
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
The health hazards associated with obesity. Mortality morbidity
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Maybe classified into:
Upper GI bleeding (proximal to DJ flexure)
Variceal bleeding
Non-variceal bleeding
Lower GI bleeding (distal to DJ flexure)
Upper GI bleeding 4x more common than lower
GI bleeding
Emergency resuscitation same for upper and
lower GI bleeds
GI Bleeding
3. Takes priority over determining the diagnosis/cause
ABC (main focus is ‘C’)
Oxygen: 15L Non-rebreath mask
2 large bore cannulae into both ante-cubital fossae
Take bloods at same time for FBC, U&E, LFT, Clotting, X match
6Units
Catheterise
IVF initially then blood as soon as available (depending on urgency: O-,
Group specific, fully X-matched)
Monitor response to resuscitation frequently (HR, BP, urine output, level of
consciousness, peripheral temperature, CRT)
Stop anti-coagulants and correct any clotting derangement
NG tube and aspiration (will help differentiate upper from lower GI bleed)
Organise definitive treatment (endoscopic/radiological/surgical)
Emergency Resuscitation
4. RR, HR, and BP can be used to estimate degree of
blood loss/hypovolaemia
Estimating Degree of Blood Loss
Class I Class II Class III Class IV
Volume Loss
(ml)
0-750 750-1500 1500-2000 >2000
Loss (%) 0-15 15-30 30-40 >40
RR 14-20 20-30 30-40 >40
HR <100 >100 >120 >140
BP Unchanged Unchanged Reduced Reduced
Urine Output
(ml/hr)
>30 20-30 5-15 Anuric
Mental State Restless Anxious Anxious/confu
sed
Confused/
lethargic
5. PC/HPC
Duration, frequency, and volume of bleeding (indicate severity of bleeding)
Nature of bleeding: will point to source
Haematemesis (fresh or coffee ground)/melaena suggest upper GI bleed. (Note a very
brisk upper GI bleed can present with dark or bright red blood PR).
PR Dark red blood suggests colon
PR Bright red blood suggests rectum, anus
If PR bleeding, is blood being passed alone or with bowel opening (if alone suggests
heavier bleeding)
If with bowel opening is blood mixed with the stool (colonic), coating the stool
(colonic/rectal), in the toilet water (anal), on wiping (anal)
Ask about associated upper or lower GI symptoms that may point to underlying cause
E.g. Upper abdominal pain/dyspeptic symptoms suggest upper GI cause such as peptic
ulcer
E.g. 2. lower abdo pain, bowel symptoms such as diarrhoea or a background of change
in bowel habit suggest lower GI cause e.g. Colitis, cancer
Previous episodes of bleeding and cause
PMH
History of any diseases that can result in GI bleeding, e.g. Peptic ulcer disease, diverticular disease,
liver disease/cirrhosis
Bleeding disorders e.g. haemophilia
DH
Anti-platelets or anti-coagulants can exacerbate bleeding
NSAIDs and steroids may point to PUD
SH
Alcoholics at risk of liver disease and possible variceal bleeding as a result
Smokers at risk of peptic ulcer disease
History in patients with GI bleeding
6. History:
PC/HOPI:
1) Duration, frequency, and volume of bleeding (indicate severity of bleeding)
2) Nature of bleeding: will point to source:
Haematemesis (fresh or coffee ground)/melaena suggest upper GI bleed.
(Note a very brisk upper GI bleed can present with dark or bright red blood
PR).
PR Dark red blood suggests colon
PR Bright red blood suggests rectum, anus
If PR bleeding, is blood being passed alone or with bowel opening (if alone
suggests heavier bleeding)
If with bowel opening is blood mixed with the stool (colonic), coating the
stool (colonic/rectal), in the toilet water (anal), on wiping (anal)
3) Ask about associated upper or lower GI symptoms that may point to
underlying cause:
E.g. Upper abdominal pain/dyspeptic symptoms suggest upper GI cause
such as peptic ulcer/ E.g. 2. lower abdo pain, bowel symptoms such as
diarrhoea or a background of change in bowel habit suggest lower GI cause
e.g. Colitis, cancer
7. PMH:
History of any diseases that can result in GI bleeding, e.g. Peptic
ulcer disease, diverticular disease, liver disease/cirrhosis
Bleeding disorders e.g. Haemophilia
DH:
Anti-platelets or anti-coagulants can exacerbate bleeding
NSAIDs and steroids may point to PUD
SH:
Alcoholics at risk of liver disease and possible variceal bleeding as
a result
Smokers at risk of peptic ulcer disease
8. Reduced level of consiousness
Pale and clammy
Cool peripheries
Reduced CRT
Tachcardic and thready pulse
Hypotensive with narrow pulse pressure
Tenderness on abdominal examination may point to underlying
cause e.g. Epigastric peptic ulcer
Stigmata of chronic liver disease (palmer erythema,
leukonychia, dupuytrens contracture, liver flap, jaundice, spider
naevi, gynacomastia, shifting dullness/ascites)
Digital rectal examination may reveal melaena, dark red blood,
bright red blood
Examination in patients with GI bleeding
9. Upper GI bleeding refers to bleeding from
oesophagus, stomach, duodenum (i.e.
Proximal to ligmanet of treitz)
Bleeding from jejunum/ileum is not common
Upper GI bleed
10. Acute Upper GI bleeding presents as:
Haematemesis (vomiting of fresh blood)
Coffee ground vomit (partially digested blood)
Melaena (black tarry stools PR)
If bleeding very brisk and severe then can
present with red blood PR!
If bleeding very slow and occult then can
present with iron deficiency anaemia
Presentation
11. Causes
Cause of Bleeding Relative Frequency
Peptic Ulcer 44
Oesophagitis 28
Gastritis/erosions 26
Duodenitis 15
Varices 13
Portal hypertensive
gastropathy
7
Malignancy 5
Mallory Weiss tear 5
Vascular Malformation 3
Other (e.g. Aortoenteric
fistula)
rare
12. Identifies patients at risk of adverse outcome
following acute upper GI bleed
Score <3 carries good prognosis
Score >8 carries high risk of mortality
Risk Stratification: Rockall Score
Variable Score 0 Score 1 Score 2 Score 3
Age <60 60-79 >80 -
Shock Nil HR >100 SBP <100 -
Co-morbidity Nil major - IHD/CCF/major
morbidity
Renal failure/liver
failure
Diagnosis Mallory Weiss
tear
All other
diagnoses
GI malignancy -
Endoscopic
Findings
None - Blood, adherent
clot, spurting
vessel
-
13. Emergency resuscitation as already described
Endoscopy
Urgent OGD (within 24hrs) – diagnostic and therepeutic
Treatment administered if active bleeding, visible vessel, adherent blood
clot
Treatment options include injection (adrenaline), coagulation, clipping
If re-bleeds then arrange urgent repeat OGD
Pharmacology
PPI (infusion) – pH >6 stabilises clots and reduces risk of re-bleeding
following endoscopic haemostasis
Tranexamic acid (anti-fibrinolytic) – maybe of benefit (more studies needed)
If H pylori positive then for eradication therapy
Stop NSAIDs/aspirin/clopidogrel/warfarin/steroids if safe to do so
(risk:benefit analysis)
Management (Non-variceal)
14. Surgery
Reserved for patients with failed medical
management (ongoing bleeding despite 2x OGD)
Nature of operation depends on cause of bleeding
(most commonly performed in context of bleeding
peptic ulcer: DU>GU)
E.g. Under-running of ulcer (bleeding DU), wedge
excision of bleeding lesion (e.g. GU), partial/total
gastrectomy (malignancy)
Management (Non-variceal)
15. Suspect if upper GI bleed in patient with history of chronic liver
disease/cirrhosis or stigmata on clinical examination
Liver Cirrhosis results in portal hypertension and development
of porto-systemic anastamosis (opening or dilatation of pre-
existing vascular channels connecting portal and systemic
circulations)
Sites of porto-systemic anastamosis include:
Oesophagus (P= eosophageal branch of L gastric v, S= oesophageal branch of
azygous v)
Umbilicus (P= para-umbilical v, S= infeior epigastric v)
Retroperitoneal (P= right/middle/left colic v, S= renal/supra-renal/gonadal v)
Rectal (P= superior rectal v, S= middle/inferior rectal v)
Furthermore, clotting derrangement in those with chronic liver
disease can worsen bleeding
Variceal Bleeds
16. Emergency resuscitation as already described
Drugs
Somatostatin/octreotide – vasoconstricts splanchnic circulation and reduces pressure in portal system
Terlipressin – vasoconstricts splanchnic circulation and reduces pressure in portal system
Propanolol – used only in context of primary prevention (in those found to have varices to reduce risk
of first bleed)
Endoscopy
Band ligation
Injection sclerotherapy
Balloon tamponade – sengstaken-blakemore tube
Rarely used now and usually only as temporary measure if failed endoscopic management
Radiological procedure – used if failed medical/endoscopic Mx
Selective catheterisation and embolisation of vessels feeding the varices
TIPSS procedure: transjugular intrahepatic porto-systemic shunt
shunt between hepatic vein and portal vein branch to reduce portal pressure and bleeding from varices): performed
if failed medical and endoscopic management
Can worsen hepatic encephalopathy
Surgical
Surgical porto-systemic shunts (often spleno-renal)
Liver transplantation (patients often given TIPP/surgical shunt whilst awaiting this)
Management of Variceal bleeds
19. Prognosis closely related to severity of underlying chronic liver
disease (Childs-Pugh grading)
Child-Pugh classification grades severity of liver disease into A,B,C
based on degree of ascites, encephalopathy, bilirubin, albumin, INR
Mortality 32% Childs A, 46% Childs B, 79% Childs C
Variceal Bleed: Prognosis
20. Lower GI bleed refers to bleeding arising distal
to the ligament of Treitz (DJ flexure)
Although this includes jejunum and ileum
bleeding from these sites is rare (<5%)
Vast majority of lower GI bleeding arises from
colon/rectum/anus
Lower GI bleeding
21. Lower GI bleeding presents as:
Dark red blood PR – more proximal bleeding point (e.g.
Distal small bowel, colon)
Bright red blood PR – more distal bleeding point (e.g. rectum,
anus)
PR blood maybe:
mixed or separate from the stool
If separate from the stool it maybe noticed in the toilet water or on
wiping
Passed with motion or alone
If blood mixed with stool (as oppose to separate from it)
suggests more proximal bleeding
If bleeding very slow and occult then can present with
iron deficiency anaemia
Presentation
22. Emergency resuscitation as already
described
Pharmacological
Stop NSAIDS/anti-platelets/anti-coagulants if safe
Tranexamic acid
Endoscopic
OGD (15% of patients with severe acute PR
bleeding will have an upper GI source!)
Colonoscopy – diagnostic and therepeutic (injection,
diathermy, clipping)
Management
23. Radiological
CT angiogram – diagnostic only (non-invasive)
Determines site and cause of bleeding
Mesenteric Angiogram – diagnostic and
therepeutic (but invasive)
Determines site of bleeding and allows
embolisation of bleeding vessel
Can result in colonic ischaemia
Nuclear Scintigraphy – technetium labelled red
blood cells: diagnostic only
Determines site of bleeding only (not cause)
Management
24. Surgical – Last resort in management as very
difficult to determine bleeding point at
laparotomy
Segmental colectomy – where site of bleeding is
known
Subtotal colectomy – where site of bleeding
unclear
Beware of small bowel bleeding – always
embarassing when bleeding continues after large
bowel removed!
Management
25. Resuscitate
Management Flow Chart for Severe
lower GI bleeding
OGD (to exclude upper GI cause for severe PR bleeding)
Colonoscopy (to identify site and cause of bleeding and to treat
bleeding by injection/diathermy/clipping) – often
unsuccesful as blood obscures views
CT angiogram (to identify site
and cause of bleeding)
Mesenteric angiogram (to identify site of
bleeding and treat bleeding by
embolisation of vessel)
Surgery
26. As 85% of lower GI bleeds will settle
spontaneously the interventions mentioned on
previous slide are reserved for:
Severe/Life threatening bleeds
In the 85% where bleeding settles
spontaneously OPD investigation is required to
determine underlying cause:
Endoscopy: flexible sigmoidoscopy, colonoscopy
Barium enema
Management
27. As 85% of lower GI bleeds will settle
spontaneously the interventions mentioned on
previous slide are reserved for:
Severe/Life threatening bleeds
In the 85% where bleeding settles
spontaneously OPD investigation is required to
determine underlying cause:
Endoscopy: flexible sigmoidoscopy, colonoscopy
Barium enema
Management