1. LOWER G.I. BLEEDING DR. JAMAL HAMDI

2. Upper G.I. Bleeding True Lower G.I. Bleeding

3. Massive G.I. Bleeding a)Diverticular disease b)Vascular ectasia

4. Causes of bleeding per rectum Cancer & Polyps Common Anorectal diseases Ischemic & Infectious Colitis Inflammatory bowel diseases Meckel ’ s diverticulum

5. History + Examination Lower G.I. Bleeding Laboratory Nasogastricaspiration Blood No Blood Proctoscopy + sigmoidscopy

6. Sigmoidscopy AnorectalPathology No Anorectal Pathology RBC Scan

7. Positive Negative Angiography Colonoscopy

8. Angiography Sitelocalized Site not localized Vasopressininfusion Segmentalresection

9. Vasopressininfusion Bleeding stop Bleeding continue Observe or Segmental resection

10. Colonoscopy Lesionfound Lesion not found Segmental resection Total Colectomy ?

11. 30-60 minutes preparation 2 hours duration Detect > 0.5 ml/min Useful in intermittent bleeding Tagged Red blood cell Scan

12. Sulfur Colloid Scan 20 minutes duration Detect > 0.1 ml/min Cleared by Liver and spleen

13. Angiography Detect 0.5 – 1.0 ml/min Identify exact vessel May identify lesion Therapeutic a) Vasopressin b) Embolisation

14. Emergency Surgery if a)Patient needed > 6 units Blood / 24 hours b)Continue bleeding after vasopressin or embolisation Thank you …