LOWER GASTROINTESTINAL BLEEDING

 RESUSCITATION

CIRCULATION

EVALUATE CAUSE

CAUSE/LESION FREQUENCY
Diverticular disease 20-40%
Angiodysplasia 10-30%
Neoplasia ~10%
Idiopathic ~ 5%
Rectal Tear  

DETERMINE SEVERITY

Indications of significant bleed

FURTHER INVESTIGATIONS

IMAGING MODALITY

Modality Sensitivity Information obtained Advantages Disadvantages
Barium Enema Diverticular disease
Intussusception
(Not angiodysplasia)
Less specialised facilities Irradiation
RBC scan 43% (stable)
86% (unstable)
Site of bleed Non-invasive Requires imaging suite
Localisation inexact
Colonoscopy 42% Less accurate in angiodysplasia Intervention possible Less useful acutely
Angiography 40% (stable)
65% (unstable)
Site of bleed Intervention possible Requires imaging suite
Radiocontrast
Risk of arterial injury

 

DEFINITIVE MANAGEMENT

80% of bleeding stops spontaneously and need no further acute management

If unstable the options are:

DISPOSAL

Discharge if:

Followup

Admit to HDU/ICU if:

Admit all others to ward

PROGNOSIS

By Clinical features

Good

Bad

By colonoscopic findings/causative lesion

LESION ACUTE REBLEEDING RATE SURGICAL RATE MORTALITY
Diverticular disease 20-55% 15-35% 5-20%
Angiodysplasia 80-90% 80-90% 10-15%