Transcript PR bleeding - Surgical Students Society of Melbourne

Dr Shi Hong Shen
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Diverticular disease
Angiodysplasia
Polyps
Carcinoma
Inflammatory Bowel Disease
Haemorrhoids
Mesenteric thrombosis
Meckels Diverticulitis
Anal fissures
Massive Upper GI bleeding
Infectious Colitis
◦ Is the patient haemodynamically stable? Vital signs?
Baseline and most recent Hb count?
◦ Blood
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 Colour, consistency, amount, over how long
Stool, bowel habits
Pain
Previous GI bleed
Past medical history
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HOPC/reason for admission
Recent GI surgery
Co morbidities
Medical conditions that can cause GI bleeding
◦ Medications
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Vital signs: BP, P, RR, T, Sats
General inspection: well, sick, critical?
◦ Level of consciousness
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ABCs
CVS: Perfusion, JVP, pulse
Abdomen: CLD, tenderness, mass
PR: haemorrhoids, fissures, masses
sigmoidoscopy
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Simple
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Advanced
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Hb
Coagulation
Group and Hold, Cross Match
UEC
LFTs
◦ Upper GI
 NG tube
 Upper GI endoscopy
◦ Lower GI
 Colonoscopy
 Angiography
 Radiolabeled red cell study
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Significant bleed, hypotensive, tachycardia,
shock
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Oxygen, sats probe
IV cannula x2 large bore (14-16G)
Foley catheter for volume status
IV fluids
See patient immediately
Ask for senior help
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Based on cause
Resuscitate
Establish diagnosis
Surgery: carcinoma, polyps, haemorrhoids,
IBD lesions