1. PR BLEEDING BY HELEN BERMINGHAM

2. MESENTERIC BLOOD VESSELS Coeliac trunk T12 foregut left gastric common heptic splenic SMA L1 midgut inferiorpancreaticoduodenal middle colic right colic intestinal ileocolic IMA L3 hind gut left colic sigmoid superior rectal

4. HISTORY COLOUR OF BLOOD EG. BRIGHT RED MIXED IN WITH STOOLS OR COATING STOOLS HOW LONG ITS BEEN HAPPENING FOR PAIN ABDOMINAL PAIN RED FLAG SYMPTOMS EG WEIGHT LOSS, ANOREXIA, CHANGE IN BOWEL HABIT, FAMILY HX ANTICOAGULATION RECENT COLONSCOPY/POLYPECTOMY

5. EXAMINATION DOES THE PATIENT LOOK WELL OR UNWELL? OBSERVATIONS HANDS/EYES/MOUTH/LYMPH NODES ABDOMEN LOOK PALPATE PERCUSS LISTEN PR

6. UNWELL PATIENT 0XYGEN 2X LARGE BORE IV ACCESS AND BLOODS FLUID CHALLENGE CORRECT WARFARIN AND STOP ANTICOAGULANTS TRANEXAMIC ACID 1G CATHETER CALL SENIOR DOCTOR

7. WELL PATIENT IV ACCESS AND BLOODS AXR, ERECT CXR CORRECT WARFARIN AND STOP ANTICOAGULANTS ENDOSCOPY OGD FLEXI SIGMIODOSCOPY COLONOSCOPY

8. MANAGEMENT CT ANGIOGRAM MESENTERIC ANGIOGRAM WITH EMBOLLISATION SURGERY

9. CAUSES OF PR BLEEDING DIVERTICULTITS 20-55% ISCHAEMIC COLITIS 20% CANCER 10-15% ANGIODYSPLASIA 10% ANORECTAL DISEASE 5-10% POST POLYPECTOMY 5% SMALL BOWEL PATHOLOGY ANGIODYSPLASIA,LYMPHOMA,ULCERS,CROHNS

10. DIVERTICULAR DISEASE DEFINITION FORMATION OF OUTPOUCHES OF COLONIC MUCOSA EXTRUDING THROUGH THE MUSCULAR WALL OF THE BOWEL PATHOGENSIS HIGH INTRALUMINAL PRESSURE, LOW FIBRE DIET POTENTIAL AREAS OF WEAK COLONIC WALL, VESSELS

11. COMPLICATIONS INFECTION FISTULA FORMATION ABSCESS FORMATION HAEMORRHAGE PERFORATION

12. ISCHAEMIC COLITIS DEFINITION ACUTE VASCULAR INSUFFICIENCY OF THE COLON PATHOGENSIS THROMBOEMBOLIC ARTERIAL OCCLUSION VENOUS OCCLUSION SYSTEMIC VASCULITIS ARTHROSCLEROSIS AND CARDIOVASCULAR DISEASE SECONDARY TO INTESTINAL OBSTRUCTION STRANGULATED HERNIA INTUSSUSCEPTION VOLVULUS PATIENTS COMPLAIN OF ABDOMINAL PAIN BLOODY DIARRHOEA USUALLY ELDERLY PATIENTS USUALLY SETTLES FLEXI SIG/COLONOSCOPY 15% DEVELOP GANGRENE- HIGH RISK OF DEATH

13. COLORECTAL CANCER 4 TH MOST COMMON CANCER IN THE UK APPROX 40,000 CASES A YEAR LIFETIME RISK 1IN 14 IN MEN, 1 IN 19 IN WOMEN.

14. COLORECTAL CANCER

15. RISK FACTORS GENETIC PRE EXISTING POLYPS INHERITED BOWEL CANCER SYNDROMES FAMILIAL ADENOMATOUS POLYPOSIS (FAP) HEREDITARY NON POLYPOSIS COLON CANCER (HNPCC) ENVIRONMENTAL INFLAMMATORY BOWEL DISEASE

16. COLORECTAL CANCER 37% RECTUM 27% SIGMOID 14% CAECUM 7% ASCENDING 3% HEPATIC FLEXURE 3% SPLENIC FLEXURE 5% CASES SYNCHRONOUS

17. COLORECTAL CANCER SYMPTOMS ANAEMIA CHANGE IN BOWEL HABIT WEIGHT LOSS PR BLEEDING/PERFORATION/FISTULA OBSTRUCTION COLONSCOPY BIOPSY STAGING CT/MRI

18. ANGIODYSPLASIA DEFINITION SMALL VESSEL MALFORMATION IN THE COLON MORE COMMON IN THE ELDERLY, RELATED TO DEGENERATION OF THE BLOOD VESSELS MORE COMMON ON THE RIGHT SIDE OF THE BOWEL COLONOSCOPY/ANGIOGRAPHY COLONOSCOPIC ELECTROCOAGULATION EMBOLISATION SURGICAL RESECTION

19. HAEMORRHOIDS DEFINITION SMALL BLOOD FILLED SWELLINGS CAUSED BY DILATED VARICOSE VEINS PREDISPOSING FACTORS CONSTIPATION AGE PREGNANCY HEREDITARY FACTORS

20. HAEMORRHOIDS

21. HAEMORRHOIDS TREATMENT TOPICAL OINTMENTS BANDING SCLEROTHERAPY SURGERY

22. ANAL FISSURE DEFINITION TEAR OR ULCER IN THE LINING OF THE ANAL CANAL CONSTIPATION TREATMENT LAXATIVES GTN/DILTIAZEM CREAM BOTOX SURGERY

23. INFLAMMATORY BOWEL DISEASE CROHNS SKIP LESIONS ANYWHERE ALONG THE GI TRACT TRANSMURAL ULCERATIVE COLITIS CONTINUOUS ULCER ONLY LARGE BOWEL MUCOSA ONLY

24. SUMMARY COMMON 50% PEOPLE/YEAR SELF LIMTING REPORTED 2-4%

25. ANY QUESTIONS?