ABC NPO, NGT decompression LGIT decompression by: Rectal tube Colonoscopy Cholinergic drugs (neostigmine) Surgery LOWER GI BLEEDING: Bleeding originating from GI source BEYOND the ligament of Trietz However, be aware that in general, we R/O upper GI sources before lower GI sources Upper GI sources of bleeding usually present with melena or occult blood, however brisk UGI bleeding can present with hematochezia Presentation Hematochezia Bright red blood per rectum Usually indicates lower GI source of bleeding (or brisk UGI source) Melena (not as often) Right sided LGI bleeding may present with darker hematochezia or melena Hemodynamic instability: Anxious Tachycardia Orthostatic hypotension (>20 SBP drop on standing) Hypotension, altered mental status/confused Etiology: Diverticulosis bleeding (MCC ~ 40%) By group: Anatomic Diverticulosis Acute hemorrhoidal bleeding & anal fissures Intussusception (currant-Jelly stool) Meckel’s diverticulum (painless) Vascular Angiodysplasia Ischemic colitis (HF, shock patient, AAA repair) Radiation induced Inflammatory Infectious colitis (e.g. pseudomembranous) IBD (ulcerative colitis) Neoplastic CRC bleeding & polyp Management & investigations:
ABC NPO, NGT decompression LGIT decompression by: Rectal tube Colonoscopy Cholinergic drugs (neostigmine) Surgery LOWER GI BLEEDING: Bleeding originating from GI source BEYOND the ligament of Trietz However, be aware that in general, we R/O upper GI sources before lower GI sources Upper GI sources of bleeding usually present with melena or occult blood, however brisk UGI bleeding can present with hematochezia Presentation Hematochezia Bright red blood per rectum Usually indicates lower GI source of bleeding (or brisk UGI source) Melena (not as often) Right sided LGI bleeding may present with darker hematochezia or melena Hemodynamic instability: Anxious Tachycardia Orthostatic hypotension (>20 SBP drop on standing) Hypotension, altered mental status/confused Etiology: Diverticulosis bleeding (MCC ~ 40%) By group: Anatomic Diverticulosis Acute hemorrhoidal bleeding & anal fissures Intussusception (currant-Jelly stool) Meckel’s diverticulum (painless) Vascular Angiodysplasia Ischemic colitis (HF, shock patient, AAA repair) Radiation induced Inflammatory Infectious colitis (e.g. pseudomembranous) IBD (ulcerative colitis) Neoplastic CRC bleeding & polyp Management & investigations:
GS+notes.docx