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Pr bleeding. By Helen Bermingham. Mesenteric blood vessels. Coeliac trunk T12 foregut left gastric common heptic splenic SMA L1 midgut inferiorpancreaticoduodenal middle colic right colic intestinal ileocolic IMA L3 hind gut left colic sigmoid superior rectal. HISTORY.

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Pr bleeding

Pr bleeding

By Helen Bermingham


Mesenteric blood vessels
Mesenteric blood vessels

Coeliac trunk T12 foregut

left gastric

common heptic

splenic

SMA L1 midgut

inferiorpancreaticoduodenal

middle colic

right colic

intestinal

ileocolic

IMA L3 hind gut

left colic

sigmoid

superior rectal


History
HISTORY

  • Colour of blood eg. Bright red

  • Mixed in with stools or coating stools

  • How long its been happening for

  • Pain

  • Abdominal pain

  • Red flag symptoms eg weight loss, anorexia, change in bowel habit,

  • Family hx

  • Anticoagulation

  • Recent colonscopy/polypectomy


Examination
Examination

  • Does the patient look well or unwell?

  • Observations

  • Hands/eyes/mouth/lymph nodes

  • Abdomen

    • Look

    • Palpate

    • Percuss

    • Listen

  • pr


Unwell patient
Unwell patient

  • 0xygen

  • 2x large bore iv access and bloods

  • Fluid challenge

  • Correct warfarin and stop anticoagulants

  • Tranexamic acid 1g

  • Catheter

  • Call senior doctor


Well patient
Well patient

  • Iv access and bloods

  • AXR, ERECT CXR

  • Correct warfarin and stop anticoagulants

  • Endoscopy

    • Ogd

    • Flexi sigmiodoscopy

    • colonoscopy


Management
management

  • Ct angiogram

  • Mesenteric angiogram with embollisation

  • surgery


Causes of pr bleeding
Causes of pr bleeding

  • DIVERTICULTITS 20-55%

  • ISCHAEMIC COLITIS 20%

  • CANCER 10-15%

  • ANGIODYSPLASIA 10%

  • ANORECTAL DISEASE 5-10%

  • POST POLYPECTOMY 5%

  • SMALL BOWEL PATHOLOGY

    • ANGIODYSPLASIA,LYMPHOMA,ULCERS,CROHNS


Diverticular disease
Diverticular disease

  • Definition

    • Formation of outpouches of colonic mucosa extruding through the muscular wall of the bowel

  • Pathogensis

    • High intraluminal pressure, low fibre diet

    • Potential Areas of weak colonic wall, vessels


  • Complications

    • Infection

    • Fistula formation

    • Abscess formation

    • haemorrhage

    • perforation


Ischaemic colitis
Ischaemic colitis

  • Definition

    • acute vascular insufficiency of the colon

  • Pathogensis

    • Thromboembolic Arterial occlusion

    • Venous occlusion

    • Systemic vasculitis

    • Arthrosclerosis and cardiovascular disease

    • Secondary to intestinal obstruction

      • Strangulated hernia

      • Intussusception

      • Volvulus

  • Patients complain of

    • Abdominal pain

    • Bloody diarrhoea

    • Usually elderly patients

  • Usually settles

  • Flexi sig/colonoscopy

  • 15% develop gangrene- high risk of death


Colorectal cancer
Colorectal cancer

  • 4th most common cancer in the uk

  • Approx 40,000 cases a year

  • Lifetime risk 1in 14 in men, 1 in 19 in women.



Colorectal cancer2
Colorectal cancer

  • Risk factors

    • Genetic

    • Pre existing polyps

    • Inherited bowel cancer syndromes

      • Familial adenomatous polyposis (fap)

      • Hereditary non polyposis colon cancer (hnpcc)

    • Environmental

    • Inflammatory bowel disease


Colorectal cancer3
Colorectal cancer

  • 37% rectum

  • 27% sigmoid

  • 14% caecum

  • 7% ascending

  • 3% hepatic flexure

  • 3% splenic flexure

  • 5% cases synchronous


Colorectal cancer4
Colorectal cancer

  • Symptoms

    • Anaemia

    • Change in bowel habit

    • Weight loss

    • Pr bleeding/perforation/fistula

    • Obstruction

  • Colonscopy

  • Biopsy

  • Staging ct/mri


Angiodysplasia
Angiodysplasia

  • Definition

    • Small vessel malformation in the colon

  • More common in the elderly, related to degeneration of the blood vessels

  • More common on the right side of the bowel

  • Colonoscopy/angiography

  • Colonoscopic electrocoagulation

  • Embolisation

  • Surgical resection


Haemorrhoids
haemorrhoids

  • Definition

    • Small blood filled swellings caused by dilated varicose veins

  • Predisposing factors

    • constipation

    • Age

    • Pregnancy

    • Hereditary factors



Haemorrhoids treatment
Haemorrhoids treatment

  • Topical ointments

  • Banding

  • Sclerotherapy

  • surgery


Anal fissure
Anal fissure

  • Definition

    • Tear or ulcer in the lining of the anal canal

  • Constipation

  • Treatment

    • Laxatives

    • gtN/diltiazem cream

    • Botox

    • surgery


Inflammatory bowel disease
Inflammatory bowel disease

  • Crohns

    • Skip lesions

    • Anywhere along the gi tract

    • transmural

  • Ulcerative colitis

    • Continuous ulcer

    • Only large bowel

    • Mucosa only


Summary
SUMMARY

  • COMMON 50% PEOPLE/YEAr

  • SELF LIMTING

  • Reported 2-4%



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