Background
- Bleeding distal to ligament of Treitz
- One fifth to one third as common as upper GI bleed
- Most commonly = upper GI bleed presenting as lower GI bleed
- Other causes include:
- Diverticulosis, Angiodysplasia, Haemorrhoids, Ischaemic colitis
- Polyp, inflammatory bowel disease, malignancy and aortoenteric fistula
Approach
- Triage and evaluate the patient on priority basis
- Primary survey to find, is patient showing signs of haemodynamic compromise
- Resuscitate the patient using standard ABCD approach
- Target oriented history,incl. PMHx of IBD, peptic ulcer, aortic surgery,etc
- Medications to note: NSAIDs, Steroids and anticoagulants
- Record vita signs and perform cardiac, pulmonary, abdominal and rectal exam
CUH Pathway
Oakland score
| Predictor | Score |
|---|---|
| Age | |
| <40 | 0 |
| 40-69 | 1 |
| ≥70 | 2 |
| Gender | |
| Female | 0 |
| Male | 1 |
| Previous LGIB admission | |
| No | 0 |
| Yes | 1 |
| DRE | |
| No blood | 0 |
| Blood | 1 |
| HR | |
| <70 | 0 |
| 70-89 | 1 |
| 90-109 | 2 |
| ≥110 | 3 |
| SBP | |
| <90 | 5 |
| 90-119 | 4 |
| 120-129 | 3 |
| 130-159 | 2 |
| ≥160 | 0 |
| Hb (g/dL) | |
| <7 | 22 |
| 7-8.9 | 17 |
| 9-10.9 | 13 |
| 11-12.9 | 8 |
| 13-15.9 | 4 |
| ≥16 | 0 |
Patients scoring ≤8, with no other indications for hospital admission are suitable for discharge from ED with follow up OPD investigations.