how to appraoach to lower gi bleeding ? - usmlevikki

[ArchivalUser]

kaplan gi internal med lecture and surgery lectures differ.
colonoscopy when?
arteriogram and embolization when?

[ArchivalUser]

http://www.asge.org/nspages/practice/pat...proach.cfm
this may help but still not clear

[ArchivalUser]

no evidence of ongoing bleed------>NG suction---->if +ve for blood----->upper gi bleed
if white gastric fluid--->mouth to pylorus is ruled out------>endoscopy to rule out duodenal bleed------>if -ve then upper gi bleed ruled out.
next step--->lower gi bleed(now confirmed since upper gi bleed is r/o from above)----->colonoscopy
PATIENT WITH ongoing LOWER GI BLEED----->r/o bleeding hemorrhoids by anoscopy(in the context of the question asked)-----> COLONOSCOPY WILL NOT PROVIDE MUCH INFO AS THE FIELD IS OBSCUREED BY BLOOD
NEXT STEP------>ARTERIOGRAM(if bleeding >2ml/min) if bleeding less than 2ml/min---->red cell tag studies.----->if no info after tagged rbc studies---->wait till bleeding stops then do colonoscopy.

[ArchivalUser]

thanks simonsez.i think i will also go with this approach.