LOWER GI BLEEDING.pptx surgical emergency

Surgical emergency and management
Focused and concised

1. LOWER GI BLEEDING PROF. B. M. GALI, MBBS, FWACS, FICS, MHPM. DEPT. OF SURGERY, UMTH MAIDUGURI

2. INTRODUCTION: Definition: Passage of blood through the anus. Fresh bright red Altered black tarry ( Melena ) Compared with upper GI its 1/5

3. Introduction cont. 95% occurs in the colon OBSCURE: bleeding source not identified after extensive search

4. PRESENTATIONS usually as hematochezia Melena if bleeding slower or from proximal source blood get digested altered and becomes black due to iron Acute often massive and endangers life Chronic often small and presents with anaemia

5. Presentations cont Frank either precedes, after or mixed with stool Less severe and intermittent can cease spontaneously may be asociated with pain, constipation or diarrhoea

6. CAUSES BRIGHT RED usually left sided colon (ANUS, RECTUM, SIGMOID, and DESENDING COLON) Anal fissure, Haemorrhoid, Benign and Malignant tumors Diverticular disease Dysentary (Amoebic and Bacillary) Imflamatory Bowel Disease(IBD); Crohns disease, Ulcerative colilitis Chronic granulomatous disease; schistosomiasis , LGV

7. CAUSES CONT MELENA; mainly right sided colon ( Caecum , Ascending colon and Transverse colon) Benign and Malignant tumors Angiodysplasia Small intestine; enteric fever, crohns disease, angiodysplasia , Benign and Malignant tumors

8. CAUSES CONT MELENA/BRIGHT RED BLOOD WITH OR WITHOUT HEMATOCHEZIA CDU,CGU Benign and Malignant tuors of stomach MISCELLANEOUS; blood disorders, intussusception , aneurysm

9. CAUSES IN CHILDREN Polyps Enterocolitis , intussusception

10. NB MASSIVE from upper Duodenal/Gastric ulcer MASSIVE from lower Haemorrhoids, Angiodysplasia Others; Amoebiasis , enteric fever

11. APPROACH TO PATIENT WITH LOWER GI BLEEDING INITIAL ASSESSMENT AND RESUSCITATION ABCs Assess magnitude of bleeding Initiate appropriate monitoring Laboratory evaluation

12. HISTORY AND EXAMINATION Identify risk factors Previous hx , dyspepsia, alcoholism, jaundice Previous surgeries Medications

13. EXAMINATIONS Pallor, sweating, pulse, BP, Mental state Portal hypertension

14. LOCALIZED BLEEDING NGT ASPIRATE ENDOSCOPY OTHERS

15. INVESTIGATIONS GENERAL FBC, GXM, Clotting profile SPECIFICS depending on cause UPPER NGT, OGD, BARIUM MEAL/FOLLOW THROUGH LOWER PROCTOSCOPY/SIGMODOSCOPY/ COLONOSCOPY

16. INVESTIGATIONS CONT COLONOSCOPY: is the mainstay allows visualization of pathology and therapeautic intervention in colonic, rectal and distal ileal sources of bleeding RADIONUCLIDE SCANING: tagged RBC with Technetium 99( patient RBC lebelled and reinjected ) ANGIOGRAPHY: selective superior or inferior mesenteric arteries

17. Stool Microscopy

18. INITIATE THERAPY PHARMACOLOGIC ENDOSCOPIC ANGIOGRAPHIC SURGICAL

19. THANK YOU