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LOWER G.I. BLEEDING DR. JAMAL HAMDI
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Upper G.I. Bleeding True Lower G.I. Bleeding
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Massive G.I. Bleeding a)Diverticular disease b)Vascular ectasia
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Causes of bleeding per rectum Cancer & Polyps Common Anorectal diseases Ischemic & Infectious Colitis Inflammatory bowel diseases Meckel ’ s diverticulum
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History + Examination Lower G.I. Bleeding Laboratory Nasogastricaspiration Blood No Blood Proctoscopy + sigmoidscopy
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Sigmoidscopy AnorectalPathology No Anorectal Pathology RBC Scan
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Positive Negative Angiography Colonoscopy
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Angiography Sitelocalized Site not localized Vasopressininfusion Segmentalresection
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Vasopressininfusion Bleeding stop Bleeding continue Observe or Segmental resection
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Colonoscopy Lesionfound Lesion not found Segmental resection Total Colectomy ?
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30-60 minutes preparation 2 hours duration Detect > 0.5 ml/min Useful in intermittent bleeding Tagged Red blood cell Scan
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Sulfur Colloid Scan 20 minutes duration Detect > 0.1 ml/min Cleared by Liver and spleen
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Angiography Detect 0.5 – 1.0 ml/min Identify exact vessel May identify lesion Therapeutic a) Vasopressin b) Embolisation
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Emergency Surgery if a)Patient needed > 6 units Blood / 24 hours b)Continue bleeding after vasopressin or embolisation Thank you …
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