Management Of Acute Lower Gastrointestinal Bleeding

Management Of Acute Lower Gastrointestinal Bleeding
Standard of Care Rounds
Presentation by:Mark J. Russo, MD
Advisor: Tracey D. Arnell, MD


OUTLINE

* Resuscitation
* Clinical Presentation
* Diagnostic Evaluation and Non-Surgical Treatment
* Surgical Management

RESUSCITATION

* Indications for transfusion
o Profuse bleeding
o Persistent hemodynamic instability despite crystalloid resuscitation
o Symptomatic anemia (CP, SOB, orthostasis with Hgb < 10)
o AMI or unstable angina with Hgb < 10
o transfused group
+ rebleeding 9 pts
+ longer clotting times in the transfused group.
o control group
+ rebleeding 1 pt
o significantly (P<0.001) more bleeding in the transfusion group
o no difference in mortality (2 vs 1)
o 300 severely anemic, postop pts who refused blood transfusion
* Canadian Critical Care Trials Group
o restrictive strategy (Hgb 7.0-9.0)
+ age < 55yo
+ less critically ill (APACHE scores < 20)
o liberal strategy (Hgb 10.0-12.0)
+ ischemic cardiac disease

Clinical presentation
Localization
Bleeding scan
Tagged rbc scan
Advantages
Disadvantages
Colonoscopy
Angiography
Vasopressin infusion
Embolization
Superselective embolization
Capsule endoscopy
Provocative bleeding study
Indications for surgery
Surgical management
Conclusions

Management Of Acute Lower Gastrointestinal Bleeding.ppt