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Diagnosis and management of lower gastrointestinal haemorrhage in the critically ill 

Diagnosis and management of lower gastrointestinal haemorrhage in the critically ill
Chapter:
Diagnosis and management of lower gastrointestinal haemorrhage in the critically ill
Author(s):

Leslie M. Kobayashi

and Raul Coimbra

DOI:
10.1093/med/9780199600830.003.0180
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date: 23 February 2020

Lower gastrointestinal bleeding (LGIB) is a common cause of anaemia, and can be a significant cause of bleeding and hypovolaemic shock. Initial treatment should always begin with protection of the airway, fluid resuscitation, and restoration of haemodynamic stability. Early colonoscopy should be utilized for all patients with brisk bleeding and elective colonoscopy for those who are stable. An alternative to endoscopy is angiography. Surgery is reserved for patients recalcitrant to endoscopy and/or angiography, or those with poor response to resuscitation. Patients with very slow haemorrhage or with occult sources of bleeding can be diagnosed with enteroscopy and CT scanning. CT is well tolerated, rapid, and repeatable, but enteroscopy has the benefit of being potentially therapeutic. Most cases of LGIB resolve spontaneously and those that do not tend to respond well to endoscopic treatment.

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