Author: Alexis Leal / Editor: Adrian Boyle / Reviewer: Isabelle Hancock, Raja Shahid Ali / Codes: A3 / Published: 07/10/2022
This session covers the assessment and management of lower gastrointestinal (GI) haemorrhage.
After completing this session you will be able to:
- Describe the measures required to evaluate the likely causes of a lower GI bleed
- List appropriate resuscitative measures in patients who have suffered a moderate to severe lower GI bleed
- Identify patients with a lower GI bleed who would benefit from early surgical review
- Identify those patients with a lower GI bleed that may be safely discharged home
- Know the causes of lower GI bleed
- Distinguish between upper and lower GI bleeding
References:
- Kollef MH, O’Brien JD, Zuckerman GR, Shannon W. BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med. 1997 Jul;25(7):1125-32.
- Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol. 1997 Jun;92(6):924-8.
- Velayos FS, Williamson A, Sousa KH, et al. Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study. Clin Gastroenterol Hepatol. 2004 Jun;2(6):485-90.
- Billingham RP, The conundrum of lower gastrointestinal bleeding. Surgical Clinics of North America. 1997 Feb:77(1): 241-252
- Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. 1988 Dec;95(6):1569-74.
- Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding. Routine outcomes and cost analysis. Gastrointest Endosc Clin N Am. 1997 Jul;7(3):477-98.
- Leitman IM, Paull DE, Shires GT 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989 Feb;209(2):175-80.
- Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997 Mar;92(3):419-24.
- Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2005 Jun 1;21(11):1281-98.
- Vernava AM, Longo WE, Virgo KS. A nationwide study of the incidence and etiology of lower gastrointestinal bleeding. Surg Res Commun 1996;18:113-120.
- Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology. 1976 Oct;71(4):577-83.
- Meyers MA, Alonso DR, Baer JW. Pathogenesis of massively bleeding colonic diverticulosis: new observations. AJR Am J Roentgenol. 1976 Dec;127(6):901-8. doi: 10.2214/ajr.127.6.901.
- American Collage of Gastroenterology (ACG) Clinical guideline. Lower GI bleeding. 2016.
- Association of Coloproctology of Great Britain and Ireland (National Comparative Audit of Lower Gastrointestinal Bleeding and the Use of Blood. Results from a National Audit. 2016.
- National Institute for Health and Care Excellence. Blood transfusion. NICE Guideline [NG24] November 2015.
- Scottish Intercollegiate Guidelines Network (SIGN) Management of acute upper and lower gastrointestinal bleeding, National Clinical Guideline 105, September 2008.
- Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997 Mar;92(3):419-24.
- Khanna A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2005 Mar;9(3):343-52.
- National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Time to get control? A review of the care received by patients who had a severe gastrointestinal haemorrhage. July, 2015.
- National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: Management. NICE [CG 141] June 2012. Last updated: August 2016.
