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HWN Suggests

Lower GI bleeding guidance. St Emlyn’s

The management of the patient with apparent lower GI (gastro-intestinal) bleeding is, in my experience at least, somewhat variable. Unlike upper GI bleeding where the standards and expectations are reasonably well known​​, the lower GI bleed patient in the ED seems to be managed at the whim however might be on call that day. This combined with the well trodden turf wars about who admits (or does not admit) the patient means that these patients can be complex. They can also be really, really sick……., or not, as the range of conditions stretches across a range of pathologies from simple haemorrhoids through to catastrophic bleeding from diverticular disease, cancer, vascular malformations and…

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 CT Angiogram for evaluation of severe hematochezia

In situations where endoscopy is not immediately available, CTA may allow for rapid and accurate evaluation of hematochezia. This may help identify which patients require immediate intervention and which patients can be safely observed.

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Aspirin and Vitamin C Together at Last

Aspirin side effects kill about a thousand people a year in the US. If aspirin were a new drug, it would have a tough time getting approved by the FDA and would only be available by prescription.

LVAD Management in the GI Bleed Patient

Mike Misch presents a case of a patient with a left ventricular assist device (LVAD) with a postoperative acute lower GI bleed and answers practical questions...

Understanding Rectal Bleeding

Rectal bleeding often reveals itself as bright red blood on the toilet paper–usually after a bowel movement–or by turning the toilet bowl water red. Rectal bleeding can also present as extremely dark stool, ranging in color from deep red/maroon to black, and sometimes appearing tar-like (melena). The color of the blood can indicate where the bleeding is occurring: Bright red blood usually indicates bleeding low in the colon or rectum Dark red or maroon blood usually indicates bleeding higher in the colon or the small bowel Melena usually indicates bleeding in the stomach, such as bleeding from ulcers

Resources

Management of acute lower GI bleeding: British Society of Gastroenterology guidelines

These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

FP Notebook

Extensive resource

Patient

The term rectal bleeding is often used by doctors to mean any blood that is passed out when you go to the toilet to pass faeces. However, not all bleeding that is passed out actually comes from the rectum. The blood can come from anywhere in the gut (the gastrointestinal tract). The more correct term is gastrointestinal tract bleeding, often abbreviated to GI bleeding.

Pediatrics Clerkship

Although gastrointestinal bleeding is worrisome for parents, unlike adult medicine, it is rarely associated with malignancies in pediatrics.

StatPearls

For lower GI bleeds, all-cause in-hospital mortality is low—less than 4%. Death from LGIB itself is rare, with most in-hospital mortality occurring from other comorbid conditions. Increased risk of death corresponded to increasing age (as seen in cases of UGIB as well), comorbid conditions, and intestinal ischemia.