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Lower Gastrointestinal Bleeding
1
Describe the initial treatment of a patient who presents with massive lower gastrointestinal (GI) bleeding
Assessment of ABCs (airway, breathing, circulation). Vital signs including orthostatics should be assessed to determine the severity of blood loss. Treatment begins with resuscitation. Place two large-bore intravenous (IV) catheters (18-guage or greater) in the upper extremities. Obtain hemoglobin and hematocrit levels, blood type, and cross-match. Frequent monitoring of vital signs should be performed to assess the resuscitation efforts with the goal of normalizing blood pressure and heart rate.
2
What is the next step in evaluating the patient?
In patients with massive hematochezia and hemodynamic instability, the placement of a nasogastric tube can be considered to rule out a brisk upper GI bleed. If the aspirate is bilious, the examiner can be fairly certain that the source is distal to the ligament of Treitz. However, if the aspirate reveals no bile, the test is nondiagnostic because the patient may still be bleeding in the duodenum with a competent pylorus.
3
What are the two most common causes of significant lower GI bleeding?
Diverticular hemorrhage (diverticulosis) and bleeding from ischemic colitis.
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