In this section : Gastrointestinal
Dysphagia
Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
Acute Pancreatitis
Suspected Variceal Bleeding
Lower Gastrointestinal Bleeding
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Lower Gastrointestinal Bleeding
Last updated 2nd June 2021
Referral
- Patients with lower GI bleeding should go to the surgeons or be transferred to surgery if inadvertently admitted to medicine.
Major Causes of Lower GI Bleeding
- Diverticular disease
- Vascular malformations (angiodysplasia)
- Ischaemic colitis
- Haemorrhoids
- Inflammatory bowel disease eg ulcerative colitis, Crohns disease
- Colon cancer or polyps
- Radiation enteropathy – usually for gynaecological and prostate cancers
- Post procedural ie colonoscopy with excision of polyp
Initial Assessment Protocol
Consider for discharge or non-admission with OP follow up if:
- Age <60 yrs AND
- Normal Haemoglobin AND
- No haemodynamic upset AND
- No evidence of gross rectal bleeding AND
- An obvious ano-rectal source of bleeding on rectal examination/sigmoidoscopy
Consider for admission if:
- Age ≥60yrs OR
- Haemodynamic upset OR
- Evidence of gross rectal bleeding OR
- Taking aspirin or an NSAID OR
- Significant comorbidity
Localising the Cause
- The cause and site of more serious lower GI bleeding should be determined by early use of colonoscopy and CT angiography
- If these measures fail to localise the bleeding point then proceed to conventional angiography
- In difficult cases technetium labelled red blood cell scans may show the site of bleeding – most useful in patients with active significant haemorrhage (>2 units transfused in previous 24hrs)
Interventions
- In patients with massive lower GI bleeding, colonoscopic haemostasis is an effective means of controlling haemorrhage from active diverticular bleeding or post-polypectomy bleeding.
- If colonoscopy fails to define site of bleeding and control haemorrhage, angiographic transarterial embolisation is recommended as an effective means of controlling haemorrhage