Here’s Dr. Freedman with today’s Morning Report!

 

The LGIB Toolbox

 

Why?

Tools for diagnosis and therapy are limited.

 

  • NG Lavage stinks.
  • RBC Scan not an ED test
  • Colonoscopy has not been shown to be useful.
    • Stable, Prepped and not hemorrhaging?
    • No clinical difference btwn emergent and delayed5,6
  • Surgery is a last-ditch effort.
    • Terrible mortality
    • 25-33% for subtotal colectomy
    • 8% for targeted resection
  • IR is good, but….
    • Hard to get
    • Varied diagnostic yield
    • Lots of complications

 

What else have we got?

CTA for LGIB

 

Perks:

  • Fast and Accurate
    • ~90 sensitive for active bleed (> 0.5cc/min)1
    • 10 minute test4
  • Risk stratify
    • If negative, 77% chance of not rebleeding3
    • May be a floor candidate?
  • Target therapy
    • Makes IR more successful1
    • Surgery less mortal
  • Identify obscure site
  • Identfiy LGIB “mimics”

 

References:

  1. Yoon W, Jeong Y Y, Shin S S. et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology. 2006;239(1):160–167
  2. Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ, Tubbs DS. Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol. 2008;191:1107–1114
  3. Chan, Victoria, et al. “Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage.”Cardiovascular and interventional radiology(2014): 1-7.
  4. Copland, Andrew, et al. “Integrating urgent multidetector CT scanning in the diagnostic algorithm of active lower GI bleeding.”Gastrointestinal endoscopy2 (2010): 402-405.
  5. Green BT, Rockey DC, Portwood G. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005;100:2395–2402
  6. Laine, A. Shah. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol, 105 (2010), pp. 2636–2641

 

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Jay Khadpe MD

  • Editor in Chief of "The Original Kings of County"
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

Categories: Gastroenterology

Jay Khadpe MD

  • Editor in Chief of “The Original Kings of County”
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

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