• Greater yield of finding the source of bleeding on colonoscopy if:
  • good prep
  • procedure done close to the time of bleeding
  • lack of blood pooling in colon
  • less sedation - narcotics can make vascular lesions difficult to see
  
  After multiple negative EGD/colonoscopies, more likely that source of bleeding is somewhere between the ampulla and the cecal valve
  
  

  Posted 12/19/16 09:51:35 AM by Anna Krigel

• In colonic ischemia -> patients typically have pain with bloody bowel movements
  In small bowel ischemia -> longer time for transit, thus pain is inconsistently related to timing of bowel movements
  
  

  Posted 12/19/16 09:52:26 AM by Anna Krigel

• Sucralfate - used for mucosal healing in the GI tract where acid is not an issue; e.g. rectal ulcers, post-esophageal ablation, partial gastrectomy/antrectomy
  
  

  Posted 12/19/16 09:56:27 AM by Anna Krigel

• Tagged RBC scan for GI bleeding
  • will detect bleeding at a rate of 0.1ml/min
  • most accurate if done within 2 hours of bleeding
  • non-invasive but no therapeutic capability
  
  Capsule endoscopy for GI bleeding
  • pill-sized capsule
  • 8 hours transit time, so no information in an actively bleeding patient until after the study is finished and images are read
  • no therapeutic capability 
  • 40-60% diagnostic yield, can identify level of bleeding and then proceed to push enteroscopy or balloon enteroscopy
  
  Push enteroscopy
  • Hard to predict how far scope will reach, sometimes to the jejunum, sometimes barely to the Ligament of Treitz
  • Balloon enteroscopy can get through the entire small bowel but it is a bigger procedure requiring OR
  
  

  Posted 12/19/16 10:09:58 AM by Anna Krigel

• For further reading...

  ACR Appropriateness Criteria for Management of Lower GI Bleeding  
  
  

  Posted 12/19/16 10:29:21 AM by Anna Krigel

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