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
- 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...
Posted 12/19/16 10:29:21 AM by Anna Krigel
Created by Christopher Kelly
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