Lower Gastrointestinal Bleeding

BLEEDING

FRANK
SMALL
BLEED

MASSIVE
BLEED
(rare)

OCCULT

ANAEMIA

Aetiology
carcinoma
polyps
angiodysplasia
carcinoma

Meckels diverticulum
intussusception
enteritis
Crohns disease

colitis
Diverticular
disease

carcinoma
proctitis
solitary ulcer

haemorrhoids
fissure
carcinoma
warts
Perianal Crohns disease

Management
Resuscitation for major bleeds
Find site
Treat the cause

Information about bleeding

Volume and frequency of bleeding
Painful defecation?
Relationship of bleeding to defecation?
[before, during (mixed into faeces or coating surface?) or after]

Associated abdominal pain?

Colour of blood?

Investigations

Bloods : FBC; U&Es; CRP; LFTs; Clotting screen; CEA

Rectal examination
Proctoscopy
Sigmoidoscopy (rigid and flexible)
Colonoscopy
(Barium Enema)
(Angiography)

Treatment
Lower GI bleed
Small volume

Large volume
Resuscitate

Investigate cause
Bleeding
stops

Bleeding
persists

Manage cause
? Surgical
intervention