Editing Lower GI bleeding (section)

== '''Investigations''' ==

* Note that initial Hb is often     at baseline as patient is losing whole blood - becomes more diluted over     about 24h
* FBE/UEC/LFT/COAG/G+H + other     tests of clotting function depending on anticoagulant
* Check for microcytosis     suggestive of chronic bleed
* Scans
** Nuclear scintigraphy with      technetium-99m-labelled RBCs: 0.04-0.1mL/min, can also detect      intermittent bleeds. However the actual LOCALISATION is sometimes poor,      so it shouldn't be used as a guide for resection target. Only gives      positive result in 39-45% LGIB.
** CT angio: 0.3-0.5mL/min in      reliable sources, although the range is wider than that and probably      depends on the scanner and how well-timed they are with the phases
* Endoscopy - start off with     gas and colon, then consider targeting small bowel
** Likely to be a hard scope -      get the most experienced colonoscopist around, and/or the person that did      the original procedure, if there was one
** Bleeding from anus/lower      rectum will reflux to at least the rectosigmoid junction
** Preferably have all      haemostasis gadgets available including APC
** ScopeGuide might help
** Don't really need to prep -      see above
** Bleeding from a previous      polypectomy site - clips if sessile, EndoLoop if pedunculated
** Anastomotic bleeding - clips      or adrenaline
** Diverticular bleed - attempt      to clip the vessel, if not possible, adrenaline
** Angiodysplasia - APC or      (second preference) adrenaline
** Consider tattooing the bowel      distal to the bleeding point, and clip locally for marking