Lower GI bleed
- Bleeding distal to ligament of Treitz.
- One fifth to one third as common as upper GI bleed.
- Most commonly = upper GI bleed presenting as lower GI bleed
- Other causes include:
- Diverticulosis, Angiodysplasia, Haemorrhoids, Ischemic colitis
- Polyp, inflammatory bowel disease, malignancy and aortoenteric fistula.
Management
- Triage and evaluate the patient on priority basis
- Quick primary survey to find, is patient showing signs of haemodynamic compromise,such as pallor, sweating, tachycardia, hypotension, tachypnoea and impaired conscious level.
- Resuscitate the patient using standard ABCD approach
- Target oriented history,incl. PMHx of IBD, peptic ulcer, aortic surgery,etc.
- Medications to note: NSAIDs,Steroids,and anticoagulants.
- Record vita signs and perform cardiac, pulmonary, abdominal and rectal exam.
Investigations
- Blood grouping and cross matching of 4 to 6 units
- FBC, Urea and electrolytes,glucose,coagulation profile
- ECG
Treatment.
- Maintain airway and provide high flow oxygen.
- Attach ECG monitor & pulse oximeter.
- Insert two large bore IV cannula in forearm veins(14G).
- IV fluids (crystalloid)or blood according to haemodynamic response.
- NG tube Urinary catheter.
- CVP line if thermodynamically unstable.
- Consult Surgical team on call.
- If the source is upper GI then PPI (Losec)infusion at a rate of 8mg /hr is recommended.
- Somatostatin should be considered in unwell patients with acute non variceal GI bleed who are likely to be bleeding from PUD, or where endoscopy is contraindicated or unavailable.[BestBets]
