Acute lower GI bleed
Discuss haematochezia?
It is the passage of fresh or altered blood per rectum usually due to colonic bleeding. However 15% of patients with severe haematochezia have a source of bleeding in the upper GI tract. Small bowel sources account for 0.7-9% cases of severe haematochezia.
Elucidate the major causes of haematochezia?
- Diverticular disease (commonest cause)
- Vascular malformation (angiodysplasia)
- Ischaemic colitis
- Haemorrhoids
- Inflammatory bowel disease
- Neoplasia (cancer or polyps)
- Radiation enteropathy
Discuss the management of bleeding PR?
- A large majority (80-85%) of lower GI bleed will stop bleeding spontaneously without any specific treatment. These patients should receive appropriate resuscitation. Colonic imaging should be organised to localise the cause of bleeding, once the bleeding has settled.
- In patients with massive lower GI haemorrhage, colonoscopic haemostasis is an effective means of controlling haemorrhage from active diverticular bleeding or post polypectomy bleeding.
- If colonoscopy fails to define site of bleeding and control haemorrhage, angiographic transarterial embolisation is recommended as an effective means of controlling haemorrhage.
- Localised segmental resection or subtotal colectomy is recommended for the management of colonic haemorrhage uncontrolled by other techniques.
Discuss the guidance for admission or discharge for patients with acute lower GI bleed?
Consider for discharge or non admission with clinic follow up
- Age < 60 and
- No evidence of haemodynamic compromise and
- No evidence of gross rectal bleeding and
- An obvious anorectal source of bleeding on rectal examination/sigmoidoscopy
Consider for admission if:
- Age >=60 or
- Haemodynamic disturbance or
- Evidence of gross rectal bleeding or
- Taking aspirin or NSAIDs or
- Significant co morbidity
Ref
