Слайд 2LOWER GI BLEEDING
Definition: LGIB is defined as bleeding from a source distal
![LOWER GI BLEEDING Definition: LGIB is defined as bleeding from a source](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/917534/slide-1.jpg)
to the ligament of Treitz
Incidence rate: 20.5 patients/ 100000/year
Слайд 3LGI hemorrhage
Sites
Colon – 95-97%
Small bowel – 3-5%
Only 15% of massive GI bleeding
Finding
![LGI hemorrhage Sites Colon – 95-97% Small bowel – 3-5% Only 15%](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/917534/slide-2.jpg)
the site
Intermittent bleeding common
Up to 42% have multiple sites
Слайд 4LGI hemorrhage
Etiology
Diverticulosis – 40-55%
Right sided lesions > left
90% stop spontaneously
10% rebleed in
![LGI hemorrhage Etiology Diverticulosis – 40-55% Right sided lesions > left 90%](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/917534/slide-3.jpg)
1st year and 25% at 4 years
Angiodysplasia – 3-20%
Most common cause of SB bleeding in >50 y/o
>50% are in right colon
Neoplasia
Typically bleed slowly
Inflammatory conditions
15% of UC patients, 1% of chron’s patients
Radiation, infectious, AIDS rarely
Vascular
Hemorrhoids
>50% have hemorrhoids, but only 2% of bleeding attributed to them
Others
Слайд 5LGI hemorrhage diagnostics
Large caliber NGT on admission
Colonoscopy
Within 12 hours in stable patients
![LGI hemorrhage diagnostics Large caliber NGT on admission Colonoscopy Within 12 hours](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/917534/slide-4.jpg)
without large amounts of bleeding
Selective viseral angiography
Need >0.5 ml/min bleeding
40-75% sensitive if bleeding at time of exam
Tagged RBC scan
Can detect bleeding at 0.1 ml/min
85% sensitive if bleeding at time of exam
Not accurate in defining left vs right colon
Слайд 7CONCLUSION
LGIB requires pre op localization to detect the bleeding source ,
![CONCLUSION LGIB requires pre op localization to detect the bleeding source ,](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/917534/slide-6.jpg)
including rectoscopy, colonoscopy,angography and nuclear scan.
Interventional treatment by colonoscopy and selective angiographic catheterization and embolization shows good results and low bleeding rates.
If an interventional therapy is not possible, a directed limited colonic or small bowel resection should be considered.