LOWER G.I. BLEEDING DR. JAMAL HAMDI

Upper G.I. Bleeding True Lower G.I. Bleeding

Massive G.I. Bleeding a)Diverticular disease b)Vascular ectasia

Causes of bleeding per rectum Cancer & Polyps Common Anorectal diseases Ischemic & Infectious Colitis Inflammatory bowel diseases Meckel ’ s diverticulum

History + Examination Lower G.I. Bleeding Laboratory Nasogastricaspiration Blood No Blood Proctoscopy + sigmoidscopy

Sigmoidscopy AnorectalPathology No Anorectal Pathology RBC Scan

Positive Negative Angiography Colonoscopy

Angiography Sitelocalized Site not localized Vasopressininfusion Segmentalresection

Vasopressininfusion Bleeding stop Bleeding continue Observe or Segmental resection

Colonoscopy Lesionfound Lesion not found Segmental resection Total Colectomy ?

30-60 minutes preparation 2 hours duration Detect > 0.5 ml/min Useful in intermittent bleeding Tagged Red blood cell Scan

Sulfur Colloid Scan 20 minutes duration Detect > 0.1 ml/min Cleared by Liver and spleen

Angiography Detect 0.5 – 1.0 ml/min Identify exact vessel May identify lesion Therapeutic a) Vasopressin b) Embolisation

Emergency Surgery if a)Patient needed > 6 units Blood / 24 hours b)Continue bleeding after vasopressin or embolisation Thank you …