0071643192.pdf

DISPOSITION

■ Disease associated with high rate of mortality

■ Admit for intervention and continual resuscitation.

■ Early consultation with gastroenterologist or surgical specialist is highly

advised.

■ Consider ICU admission.

Lower GI Bleeding

ETIOLOGIES

Diverticulosis (most common), tumors, angiodysplasia, polyps, hemorrhoids

or brisk upper GI bleeds, and aortoenteric fistula in patients with history of

aortic stent

SYMPTOMS

■ Hematochezia

■ Abdominal pain

■ Weight loss

■ Change in bowel pattern

■ Hypovolemia or signs of shock

DIAGNOSIS

■ Rectal exam for presence of blood and anoscopy as indicated.

■ Angiography can localize site of bleeding if rate >0.5 mL/min.

■ Tagged red blood scan can localize the site of bleeding if rate >0.1 mL/min;

not as good at localizing site of bleeding as angiography.

■ Colonoscopy (after bowel prep if patient is stable)

■ CBC, coagulation profile, type, and crossmatch

TREATMENT

■ Fluid resuscitation

■ Packed red blood cells if patient has ongoing bleeding or is symptomatic

after 2 liters of IVF

■ Replace coagulation factors as needed.

■ Vitamin K if INR is high

■ Vasopressin after angiography may be beneficial.

■ Definitive treatment includes selective embolization, endoscopic coagula-

tion, and surgical resection.

DISPOSITION

■ Most GI bleeds should be admitted.

■ Low-risk patients (hemorrhoids, fissures, and proctitis) may be safely dis-

charged if they have adequate follow-up care.

STOMACH

Gastritis

May be due to stress, burns, sepsis, drugs (ASA and NSAIDs), alcohol,

autoimmune conditions, or H. pyloribacterial infection

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Ten percent of apparent lower

GI bleeds are actually caused

by upper GI bleeds.

Lower GI Bleeds—

DRAIN

Diverticulosis

Radiation or Ischemic

Colitis

AVMs, angiodysplasia

Inflammatory bowel

disease (IBD)

Neoplasms (Cancer)