1 / 12

Approach to a Patient with Lower GI Bleeding

Approach to a Patient with Lower GI Bleeding. Antonio. Aramburo. Arcilla. Argana. Patient. L. Q. 78 y/o Female Chief Complaint: Hematochezia. Salient Features:. Chief Complaint: Hematochezia 6 hours PTA- ½ teaspoon of blood after defecation 4 hours PTA- 1 tablespoon of blood

bernie
Télécharger la présentation

Approach to a Patient with Lower GI Bleeding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Approach to a Patient with Lower GI Bleeding Antonio. Aramburo. Arcilla. Argana

  2. Patient • L. Q. • 78 y/o • Female • Chief Complaint: Hematochezia

  3. Salient Features: • Chief Complaint: Hematochezia • 6 hours PTA- ½ teaspoon of blood after defecation • 4 hours PTA- 1 tablespoon of blood • 30 mins PTA- 2 cupfuls of fresh blood -Dizzy, cold clammy perspiration

  4. Approach to the Patient: Lower Gastrointestinal Bleeding • Measure the heart rate and blood pressure

  5. Approach to the Patient: Lower Gastrointestinal Bleeding • Differentiation of upper from lower GIB • Hematemesis- indicates upper GI source of bleeding • Hematochezia- usually represents lower GI source of bleeding

  6. Approach to the Patient: Lower Gastrointestinal BleedingDiagnostic Evaluation of the Patient with Lower GIB Upper endoscopy – to rule out an upper GI source before evaluation of lower GI tract -Patients with hematochezia and hemodynamic instability

  7. Diagnostic Evaluation of the Patient with Lower GIB • Sigmoidoscopy • for patients <40 years old with minor bleeding • for detection of obvious, low-lying lesions • risk of bleeding, area of bleeding is usually not possible to identify

  8. Diagnostic Evaluation of the Patient with Lower GIB • Colonoscopy- procedure of choice

  9. Diagnostic Evaluation of the Patient with Lower GIB • Tc-labeled red cell scan -allows repeated imaging for up to 24 hours - may identify the general location of bleeding

  10. Diagnostic Evaluation of the Patient with Lower GIB • Angiography - can detect the site of bleeding - permits treatment with intraarterial infusion of vasopressin or embolization - may identify lesions with abnormal vasculature, such as tumors or vascular ectasias

  11. Figure 1.1 Suggested algorithm for patients with acute lower gastrointestinal bleeding

  12. Differential Diagnosis • Common causes of LGIB • Diverticula • Vascular ectasia (Angiodysplasia) • Neoplasms (Adenocarcinoma)

More Related