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Lower GI Bleed

Mel Herbert, MD MBBS FAAEM and Stuart Swadron, MD, FRCPC

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Crunch Time EM - Gastro - Written Summary 304 KB - PDF

Lower GI Bleed

Mel Herbert MD and Stuart Swadron MD

  • Acute vs chronic
  • Common causes
    • Diverticular disease (most common)
    • Vascular causes
      • AVM/angiodysplasia (elderly), ischemia, post-radiation treatment, hemorrhoids
  • Inflammatory
    • IBD, infection
  • Neoplastic
  • Post-procedure (e.g. post-polypectomy)
  • Always ask
    • Quality/quantity of blood
    • Recent beet ingestion (a common “red” herring!)
    • Recent procedures
    • Cancer
    • IBD
    • Anticoagulants
  • General rule - the darker the blood, the further the source is from the rectum
  • BUT very brisk upper GI bleed can cause bright red blood per rectum
  • Physical exam
    • Vitals, and other signs of shock
    • Abdominal exam and DRE with hemoccult
  • Labs
    • CBC, type and screen, +/- coags
    • Stool culture if possibly infectious
  • Imaging options
    • Very institution-dependent
    • Radionuclide imaging
    • Angiography/CT angiography to identify the source of active bleeding
  • Colonoscopy
    • Therapeutic and diagnostic
    • Requires prep and patients must be stabilized first
  • Treatment
    • Monitor closely
    • Supportive measures
    • Resuscitation
    • Correct coagulopathies
    • GI consultation
    • Surgery if massive bleeding
  • Disposition
    • Almost all admitted
    • If insignificant hemorrhoidal bleeding or something similar → discharge

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Gastro Full episode audio for MD edition 85:15 min - 118 MB - M4ACrunch Time EM - Gastro - Individual MP3 Files 160 MB - ZIPCrunch Time EM - Gastro - Written Summary 304 KB - PDF

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