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Old 06-05-2012
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GIT GI Bleeding Discussion

If pt presents with ______________ and you did Upper and Lower GI endoscopy and did not find the source of the bleeding..what is your NEXT STEP IN MANAGEMENT?

1.upper GI bleeding----->
2.lower GI bleeding----->
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I think standard is to do an Angiogram for both and figure out the location.

According to KLN surgery, they classify bleeds into upper and lower, and also state that younger adults will tend to have upper GI bleeds exclusively, and elder can have both.

Now, in terms of the diagnosis, you have a choice of "-scopy", angiogram etc. to pin point the cause of the bleed. Obviously I think best initial test to figure out the source is "-scopy", and after which would be angiogram.
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Originally Posted by usmledee View Post
If pt presents with ______________ and you did Upper and Lower GI endoscopy and did not find the source of the bleeding..what is your NEXT STEP IN MANAGEMENT?

1.upper GI bleeding----->
2.lower GI bleeding----->

somewhere i have read if the cause of GI bleeding is not obvious on upper and lower GI endoscopy,then the best test is to do CAPSULE ENDOSCOPY to look for cause in small bowel ........!!!!
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Originally Posted by K06100 View Post
somewhere i have read if the cause of GI bleeding is not obvious on upper and lower GI endoscopy,then the best test is to do CAPSULE ENDOSCOPY to look for cause in small bowel ........!!!!
Yes very good.. Capsule endoscopy recommended to find SI bleeds that cannot be identified with U&L endoscopies.

As for the second (lower GI bleed). Arteriogram is partially the answer, but it should first be preceeded by Tc99 labelled erythrocyte scintigraphy.
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this is for Lower:
• Colonoscopy if stable; arteriography or exploratory laparotomy if unstable.
• If endoscopy is negative:
○ Nuclear Bleeding scan
Detect low volume bleeding 0.1-0.5ml/min.
○ Arteriography
Detect only large volume bleeding >0.5ml/min.
Useful in extremely high volume bleeding (where visualization with endoscopy is difficult)
May help to embolize the site of bleeding or inject local vasopressin.

Capsule endoscopy is used when all above are negative. (usually small intestine bleeding).

for upper
• NG tube and NG lavage. (first !)
• Endoscopy if stable (the most accurate test).

and like told above: young --> upper bleeding, and if lower usually investigated by no more than anoscopy/sigmoidoscopy
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Originally Posted by bisho View Post

and like told above: young --> upper bleeding, and if lower usually investigated by no more than anoscopy/sigmoidoscopy
What is the cut off age when you say young?
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Quote:
Originally Posted by usmledee View Post
What is the cut off age when you say young?
i really dont know but lets pick <50 with no heart dz as a good cutoff
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