PR BLEEDINGBY HELEN BERMINGHAM

MESENTERIC BLOOD VESSELS

Coeliac trunk T12 foregutleft gastriccommon hepticsplenic

SMA L1 midgutinferiorpancreaticoduodenalmiddle colicright colicintestinalileocolic

IMA L3 hind gutleft colicsigmoidsuperior rectal

HISTORY

• COLOUR OF BLOOD EG. BRIGHT RED

• MIXED IN WITH STOOLS OR COATING STOOLS

• HOW LONG ITS BEEN HAPPENING FOR

• PAIN

• ABDOMINAL PAIN

• RED FLAG SYMPTOMS EG WEIGHT LOSS, ANOREXIA, CHANGE IN BOWEL HABIT,

• FAMILY HX

• ANTICOAGULATION

• RECENT COLONSCOPY/POLYPECTOMY

EXAMINATION

• DOES THE PATIENT LOOK WELL OR UNWELL?

• OBSERVATIONS

• HANDS/EYES/MOUTH/LYMPH NODES

• ABDOMEN• LOOK

• PALPATE

• PERCUSS

• LISTEN

• PR

UNWELL PATIENT

• 0XYGEN

• 2X LARGE BORE IV ACCESS AND BLOODS

• FLUID CHALLENGE

• CORRECT WARFARIN AND STOP ANTICOAGULANTS

• TRANEXAMIC ACID 1G

• CATHETER

• CALL SENIOR DOCTOR

WELL PATIENT

• IV ACCESS AND BLOODS

• AXR, ERECT CXR

• CORRECT WARFARIN AND STOP ANTICOAGULANTS

• ENDOSCOPY

• OGD

• FLEXI SIGMIODOSCOPY

• COLONOSCOPY

MANAGEMENT

• CT ANGIOGRAM

• MESENTERIC ANGIOGRAM WITH EMBOLLISATION

• SURGERY

CAUSES OF PR BLEEDING

• DIVERTICULTITS 20-55%

• ISCHAEMIC COLITIS 20%

• CANCER 10-15%

• ANGIODYSPLASIA 10%

• ANORECTAL DISEASE 5-10%

• POST POLYPECTOMY 5%

• SMALL BOWEL PATHOLOGY• ANGIODYSPLASIA,LYMPHOMA,ULCERS,CROHNS

DIVERTICULAR DISEASE• DEFINITION

• FORMATION OF OUTPOUCHES OF COLONIC MUCOSA EXTRUDING THROUGH THE MUSCULAR WALL OF THE BOWEL

• PATHOGENSIS

• HIGH INTRALUMINAL PRESSURE, LOW FIBRE DIET

• POTENTIAL AREAS OF WEAK COLONIC WALL, VESSELS

• COMPLICATIONS

• INFECTION

• FISTULA FORMATION

• ABSCESS FORMATION

• HAEMORRHAGE

• PERFORATION

ISCHAEMIC COLITIS• DEFINITION

• ACUTE VASCULAR INSUFFICIENCY OF THE COLON

• PATHOGENSIS

• THROMBOEMBOLIC ARTERIAL OCCLUSION

• VENOUS OCCLUSION

• SYSTEMIC VASCULITIS

• ARTHROSCLEROSIS AND CARDIOVASCULAR DISEASE

• SECONDARY TO INTESTINAL OBSTRUCTION

• STRANGULATED HERNIA

• INTUSSUSCEPTION

• VOLVULUS

• PATIENTS COMPLAIN OF

• ABDOMINAL PAIN

• BLOODY DIARRHOEA

• USUALLY ELDERLY PATIENTS

• USUALLY SETTLES

• FLEXI SIG/COLONOSCOPY

• 15% DEVELOP GANGRENE- HIGH RISK OF DEATH

COLORECTAL CANCER

• 4TH MOST COMMON CANCER IN THE UK

• APPROX 40,000 CASES A YEAR

• LIFETIME RISK 1IN 14 IN MEN, 1 IN 19 IN WOMEN.

COLORECTAL CANCER

COLORECTAL CANCER

• RISK FACTORS

• GENETIC

• PRE EXISTING POLYPS

• INHERITED BOWEL CANCER SYNDROMES

• FAMILIAL ADENOMATOUS POLYPOSIS (FAP)

• HEREDITARY NON POLYPOSIS COLON CANCER (HNPCC)

• ENVIRONMENTAL

• INFLAMMATORY BOWEL DISEASE

COLORECTAL CANCER

• 37% RECTUM

• 27% SIGMOID

• 14% CAECUM

• 7% ASCENDING

• 3% HEPATIC FLEXURE

• 3% SPLENIC FLEXURE

• 5% CASES SYNCHRONOUS

COLORECTAL CANCER

• SYMPTOMS• ANAEMIA• CHANGE IN BOWEL HABIT• WEIGHT LOSS• PR BLEEDING/PERFORATION/FISTULA• OBSTRUCTION

• COLONSCOPY

• BIOPSY

• STAGING CT/MRI

ANGIODYSPLASIA

• DEFINITION• SMALL VESSEL MALFORMATION IN THE COLON

• MORE COMMON IN THE ELDERLY, RELATED TO DEGENERATION OF THE BLOOD VESSELS

• MORE COMMON ON THE RIGHT SIDE OF THE BOWEL

• COLONOSCOPY/ANGIOGRAPHY

• COLONOSCOPIC ELECTROCOAGULATION

• EMBOLISATION

• SURGICAL RESECTION

HAEMORRHOIDS

• DEFINITION

• SMALL BLOOD FILLED SWELLINGS CAUSED BY DILATED VARICOSE VEINS

• PREDISPOSING FACTORS

• CONSTIPATION

• AGE

• PREGNANCY

• HEREDITARY FACTORS

HAEMORRHOIDS

HAEMORRHOIDS TREATMENT

• TOPICAL OINTMENTS

• BANDING

• SCLEROTHERAPY

• SURGERY

ANAL FISSURE

• DEFINITION• TEAR OR ULCER IN THE LINING OF THE ANAL CANAL

• CONSTIPATION

• TREATMENT• LAXATIVES

• GTN/DILTIAZEM CREAM

• BOTOX

• SURGERY

INFLAMMATORY BOWEL DISEASE

• CROHNS

• SKIP LESIONS

• ANYWHERE ALONG THE GI TRACT

• TRANSMURAL

• ULCERATIVE COLITIS

• CONTINUOUS ULCER

• ONLY LARGE BOWEL

• MUCOSA ONLY

SUMMARY

• COMMON 50% PEOPLE/YEAR

• SELF LIMTING

• REPORTED 2-4%

ANY QUESTIONS?