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Abdul-WAHID M Salih Dept. of surgery / School of Medicine University of Sulaimani.
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Lower GI Hemorrhage Dr.AbdulWAHID M Salih
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LGI hemorrhage *Intermittent bleeding common Colon (95-97%)
Small bowel (3-5%) * Only 15% of massive GI bleeding * Finding the site *Intermittent bleeding common * Up to 42% have multiple sites
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Bleeding diverticulosis
Colonic angiodysplasia
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Diverticulosis – 40-55% * 90% stop * spontaneously
* 10% rebleed in 1st year and 25% at 4 years Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
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argon plasma coagulation
Angiodysplasia (3-20%) >50 y/o >50% are in right colon Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy. argon plasma coagulation
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Neoplasia Typically bleed slowly
Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
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Inflammatory conditions
15% of UC patients, 1% of chron’s patients Radiation Infectious AIDS rarely Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
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Hemorrhoids * >50% have hemorrhoids
* but only 2% of bleeding attributed to them Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.
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Meckels Diverticulum * The most common cause of massive bleeding in pediatric patients
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Evaluation * Same for UGI bleed
If unstable with hematochezia need EGD 1st
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Diagnostics * Colonoscopy * Video capsule endoscopy
* Intraoperative endoscopy
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Selective viseral angiography
* Need >0.5 ml/min bleeding * 40-75% sensitive if bleeding at time of exam
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Tagged RBC scan Can detect bleeding at 0.1 ml/min
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Meckel’s scan Initial test for patients <30 years old
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Enteroclysis * Ulcerations * Inflammation
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CT scan * Tumors * Inflammation * Diverticuli
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GI hemorrhage from unknown source
Only 2-5% are not upper or lower
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Treatment * Theraputic Endoscopy: * Diagnostic polypectomy sites
Angiodysplasia polypectomy sites
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Angiographic * Selective embolization for poor surgical candidates
* Can lead to ischemic sites requiring later resection
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Surgery * Ongoing hemorrhage, >6 units
* Ongoing transfusion requirement Site selection Intraoperative endoscopy Segmental resection
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THANKS
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