Investigations useful for Lower GI bleeding | Crack PGIMER NOV 2016

Investigations useful for Lower GI bleeding includes

A. RBC Scan
B. Upper GI endoscopy
C. Colonscopy
D. Mesenteric angiography
E. Prosctoscopy

The answer is. B. Upper GI endoscopy, C. Colonscopy, D. Mesenteric angiography, E. Prosctoscopy

After resuscitation has been initiated, the first step in theworkup is to rule out anorectal bleeding with a digital rectalexam and anoscopy or sigmoidoscopy. With significantbleeding, it is also important to eliminate an upper GI source.

An NG aspirate that contains bile and no blood effectively rulesout upper tract bleeding in most patients. However, whenemergent surgery for life-threatening hemorrhage is beingcontemplated, preoperative or intraoperative EGD is usuallyappropriate. This is particularly relevant if blind subtotalcolectomy for massive hemorrhage is being considered.

Subsequent evaluation depends on the magnitude of thehemorrhage. With major or persistent bleeding, the workupprogresses depending on the patient's hemodynamicstability.Colonoscopy is the mainstay of diagnosis because itallows both visualization of the pathology and therapeuticintervention in colonic, rectal, and distal ileal sources ofbleeding. The usual adjuncts to colonoscopy include taggedRBC scan and angiography. If these modalities are notdiagnostic, the source of the hemorrhage is considered obscure(these lesions and their evaluation are considered in the finalsection).

Selective angiography, using either the superior or inferiormesenteric arteries, can detect hemorrhage in the range of 0.5to 1.0 mL/min and is generally only employed in the diagnosisof ongoing hemorrhage. It can be particularly useful inidentifying the vascular patterns of angiodysplasias.