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PR bleeding

PR bleeding . Dr Shi Hong Shen. Causes of PR bleeding. Diverticular disease Angiodysplasia Polyps Carcinoma Inflammatory Bowel Disease Haemorrhoids Mesenteric thrombosis Meckels Diverticulitis Anal fissures Massive Upper GI bleeding Infectious Colitis. History.

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PR bleeding

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  1. PR bleeding Dr Shi Hong Shen

  2. Causes of PR bleeding • Diverticular disease • Angiodysplasia • Polyps • Carcinoma • Inflammatory Bowel Disease • Haemorrhoids • Mesenteric thrombosis • Meckels Diverticulitis • Anal fissures • Massive Upper GI bleeding • Infectious Colitis

  3. History • Is the patient haemodynamically stable? Vital signs? Baseline and most recent Hb count? • Blood • Colour, consistency, amount, over how long • Stool, bowel habits • Pain • Previous GI bleed • Past medical history • HOPC/reason for admission • Recent GI surgery • Co morbidities • Medical conditions that can cause GI bleeding • Medications

  4. Examination • Vital signs: BP, P, RR, T, Sats • General inspection: well, sick, critical? • Level of consciousness • ABCs • CVS: Perfusion, JVP, pulse • Abdomen: CLD, tenderness, mass • PR: haemorrhoids, fissures, masses • sigmoidoscopy

  5. Investigations • Simple • Hb • Coagulation • Group and Hold, Cross Match • UEC • LFTs • Advanced • Upper GI • NG tube • Upper GI endoscopy • Lower GI • Colonoscopy • Angiography • Radiolabeled red cell study

  6. Red flags and immediate management • Significant bleed, hypotensive, tachycardia, shock • Oxygen, sats probe • IV cannulax2 large bore (14-16G) • Foley catheter for volume status • IV fluids • See patient immediately • Ask for senior help

  7. Management • Based on cause • Resuscitate • Establish diagnosis • Surgery: carcinoma, polyps, haemorrhoids, IBD lesions

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