Surgery 6th year, Tutorial (Dr. AbdulWahid)
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Transcript of Surgery 6th year, Tutorial (Dr. AbdulWahid)
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Lower GI Hemorrhage
ABDWAHID M SALIS, M.D
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LGI hemorrhage
Colon – 95-97%
Small bowel – 3-5%Only 15% of massive GI bleedingFinding the site
Intermittent bleeding common
Up to 42% have multiple sites
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Hematochezia: Bright red stool, called, is the sign of a fast
moving active GI bleed
Maroon color:
short time taken from the site of the bleed and the exiting at the anus
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Causes
Coagulopathy - specifically a bleeding diathesis
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Bleeding diverticulosis
Colonic angiodysplasia
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Diverticulosis – 40-55%
90% stop spontaneously
10% rebleed in 1st year
and 25% at 4 years
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Angiodysplasia – 3-20%
– >50 y/o–>50% are in right colon
argon plasma coagulation
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Neoplasia
–Typically bleed slowly
–Polyps
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Inflammatory conditions
15% of UC patients,
1% of chron’s patients
Ischaemic
Radiation
Infectious
AIDS rarely
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Hemorrhoids
–>50% have hemorrhoids,– but only 2%
of bleeding
attributed to them
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Meckels Diverticulum
The most common cause of massive bleeding in pediatric patients
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Evaluation
Same for UGI bleedIf unstable with hematochezia
need EGD 1st
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Concealed Bleeding
Occasionally, a person with a LGIB will not present with any signs of internal bleeding.
A Diagnostic or pre-assessment: hypotension, tachycardia, angina, syncope, weakness, confusion, stroke, myocardial infarction/heart attack, and shock.
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Laboratory test
Hemoglobin, hematocrit, and platelets Partial thromboplastin time (PTT) and INR
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Diagnostics
ColonoscopyVideo capsule endoscopyIntraoperative endoscopy
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Selective viseral angiography
Need >0.5 ml/min bleeding40-75% sensitive if bleeding at time
of exam
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Tagged RBC scan
Can detect bleeding at 0.1 ml/min
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Meckel’s scanInitial test for patients <30 years old
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Enteroclysis
Ulcerations
Inflammation
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CT scan
Tumors Inflammation Diverticuli
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GI hemorrhage from unknown source
Only 2-5% are not upper or lower
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Treatment
Endoscopy:
Theraputic Angiodysplasia polypectomy sites
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Angiographic
– Selective embolization for poor surgical candidates
– Can lead to ischemic sites requiring later resection
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SurgeryOngoing hemorrhage, >6 units ongoing transfusion requirement
Site selection
Intraoperative endoscopy
Segmental resection
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لله الحمد