1. Dr Shi Hong Shen

2. 1. Diverticular disease 2. Angiodysplasia 3. Polyps 4. Carcinoma 5. Inflammatory Bowel Disease 6. Haemorrhoids 7. Mesenteric thrombosis 8. Meckels Diverticulitis 9. Anal fissures 10. Massive Upper GI bleeding 11. Infectious Colitis

3. ◦ Is the patient haemodynamically stable? Vital signs? Baseline and most recent Hb count? ◦ Blood  Colour, consistency, amount, over how long ◦ Stool, bowel habits ◦ Pain ◦ Previous GI bleed ◦ Past medical history  HOPC/reason for admission  Recent GI surgery  Co morbidities  Medical conditions that can cause GI bleeding ◦ Medications

4.  Vital signs: BP, P, RR, T, Sats  General inspection: well, sick, critical? ◦ Level of consciousness  ABCs  CVS: Perfusion, JVP, pulse  Abdomen: CLD, tenderness, mass  PR: haemorrhoids, fissures, masses  sigmoidoscopy

5.  Simple ◦ Hb ◦ Coagulation ◦ Group and Hold, Cross Match ◦ UEC ◦ LFTs  Advanced ◦ Upper GI  NG tube  Upper GI endoscopy ◦ Lower GI  Colonoscopy  Angiography  Radiolabeled red cell study

6.  Significant bleed, hypotensive, tachycardia, shock ◦ Oxygen, sats probe ◦ IV cannula x2 large bore (14-16G) ◦ Foley catheter for volume status ◦ IV fluids ◦ See patient immediately ◦ Ask for senior help

7.  Based on cause  Resuscitate  Establish diagnosis  Surgery: carcinoma, polyps, haemorrhoids, IBD lesions