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Acute Lower Gastrointestinal Bleeding

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Evidence-Based Critical Care

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Abstract

Hemodynamically unstable hematochezia is an uncommon manifestation of lower gastrointestinal bleeding. However, given the usually older age and multiple comorbidities of the typical patient, acute lower gastrointestinal bleeding can be associated with poor outcomes unless emergent life-saving care is delivered. In this context, early recognition and aggressive resuscitation is essential for a patient presenting with hemodynamically significant hematochezia. Accurate discrimination between upper and lower gastrointestinal sources of hemorrhage is of utmost importance as this has significant implications with respect to prognosis, differential diagnosis, and provides guidance for additional diagnostic testing, such as endoscopy, as well as life-saving therapeutic interventions. Depending on clinical stability and severity of bleeding, diagnosis may require urgent colonoscopy, nuclear red blood cell scan, multidetector CT of the abdomen, and/or mesenteric angiography. Colonoscopy and mesenteric angiography may be both diagnostic and therapeutic when performed. Optimal management of a patient with acute lower gastrointestinal bleeding requires consultation and coordination of a multidisciplinary team of expert specialists to improve patient outcomes.

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References

  1. Zuccaro Jr G. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 1998;93:1202.

    Article  PubMed  Google Scholar 

  2. ASGE Standards of Practice Committee, Pasha SF, Shergill A, Acosta RD, et al. The role of endoscopy in the patient with lower GI bleed. Gastrointest Endosc. 2014;79(6):875–85.

    Article  Google Scholar 

  3. Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92:491.

    Article  PubMed  Google Scholar 

  4. Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2005;21:1281.

    Article  CAS  PubMed  Google Scholar 

  5. Ebert RV, Stead EA, Gibson JG. Response of normal subjects to acute blood loss. Arch Intern Med. 1941;68:578.

    Article  CAS  Google Scholar 

  6. Bounds BC, Kelsey PB. Lower gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2007;17:273.

    Article  PubMed  Google Scholar 

  7. Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol. 2009;6:637.

    Article  PubMed  Google Scholar 

  8. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012;307:1072.

    Article  CAS  PubMed  Google Scholar 

  9. Cuellar RE, Gavaler JS, Alexander JA, Brouillete DE, et al. Gastrointestinal tract hemorrhage. The value of nasogastric aspirate. Arch Intern Med. 1990;150:1380.

    Article  Google Scholar 

  10. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. 1988;95:1569.

    Article  CAS  PubMed  Google Scholar 

  11. Green BT, Rockey DC, Portwood G, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005;100:2395.

    Article  PubMed  Google Scholar 

  12. Strate LL, Syngal S. Predictors of utilization of early colonoscopy vs radiography for severe lower intestinal bleeding. Gastrointest Endosc. 2005;61:46.

    Article  PubMed  Google Scholar 

  13. Rossini FP, Ferrari A, Spandre M, et al. Emergency colonoscopy. World J Surg. 1989;13:190.

    Article  CAS  PubMed  Google Scholar 

  14. Elta GH. Urgent colonoscopy for acute lower GI bleeding. Gastrointest Endosc. 2004;59:402.

    Article  PubMed  Google Scholar 

  15. Wong Kee Song LM, Baron TH. Endoscopic management of acute lower gastrointestinal bleeding. Am J Gastroenterol. 2008;103:1881.

    Article  PubMed  Google Scholar 

  16. Khanna A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2008;9:343.

    Article  Google Scholar 

  17. Bokhari M, Vernava AM, Ure T, Longo WE. Diverticular hemorrhage in the elderly—is it well tolerated? Dis Colon Rectum. 1996;39:191.

    Article  CAS  PubMed  Google Scholar 

  18. Ansari MZ, Collopy BT, Hart WG, et al. In-hospital mortality and associated complicatons after bowel surgery in Victorian public hospitals. Aust N Z J Surg. 2000;70:6.

    Article  CAS  PubMed  Google Scholar 

  19. Velayos FS, Williamson A, Sousa KH, et al. Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study. Clin Gastroenterol Hepatol. 2004;2:485.

    Article  PubMed  Google Scholar 

  20. Kollef MH, Canfield DA, Zuckerman GA. Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit. Crit Care Med. 1995;23:1048.

    Article  CAS  PubMed  Google Scholar 

  21. Kollef MH. Crit Care Med. 1997;25:1125; Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Int Med. 2003;163:838.

    Google Scholar 

  22. Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163:838.

    Article  PubMed  Google Scholar 

  23. Strate LL, Saltzman JR, Ookubo R, et al. Validation of a clinical prediction rule for severe acute lower intestinal bleeding. Am J Gastroenterol. 2005;100:1821.

    Article  PubMed  Google Scholar 

  24. Das A, Ben-Menachem T, Cooper GS, et al. Prediction of outcome in acute lower-gastrointestinal haemorrhage based on an artificial neural network: internal and external validation of a predictive model. Lancet. 2003;362:1261.

    Article  PubMed  Google Scholar 

  25. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368:11.

    Article  CAS  PubMed  Google Scholar 

  26. Wu WC, Wu WC, Rathore SS, Wang Y, et al. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001;345:1230.

    Article  CAS  PubMed  Google Scholar 

  27. American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) student course manual. 9th ed. Chicago: American College of Surgeons; 2012.

    Google Scholar 

  28. Kautza BC, Cohen MJ, Cuschieri J, et al. Changes in massive transfusion over time: an early shift in the right direction? J Trauma Acute Care Surg. 2012;72:106.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hardy JF, De Moerloose P, Samama M, et al. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anaesth. 2004;51:293.

    Article  PubMed  Google Scholar 

  30. Dusold R, Burke K, Carpentier W, Dyck WP. The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding. Am J Gastroenterol. 1994;89:345.

    CAS  PubMed  Google Scholar 

  31. Olds GD, Cooper GS, Chak A, et al. The yield of bleeding scans in acute lower gastrointestinal hemorrhage. J Clin Gastroenterol. 2005;39:273.

    Article  PubMed  Google Scholar 

  32. Feingold DL, Caliendo FJ, Chinn BT, et al. Does hemodynamic instability predict positive technetium-labeled red blood cell scintigraphy in patients with acute lower gastrointestinal bleeding? A review of 50 patients. Dis Colon Rectum. 2005;48:1001.

    Article  PubMed  Google Scholar 

  33. García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, et al. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol. 2013;23:1181.

    Article  PubMed  Google Scholar 

  34. Kim CY, Suhocki PV, Miller Jr MJ, et al. Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study. J Vasc Interv Radiol. 2010;21:477.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Ali Abedi

  2. Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio and the Audie L. Murphy VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, USA

    Anoop M. Nambiar

Authors
  1. Ali Abedi
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  2. Anoop M. Nambiar
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Correspondence to Anoop M. Nambiar .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA

    Robert C. Hyzy

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Abedi, A., Nambiar, A.M. (2017). Acute Lower Gastrointestinal Bleeding. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_65

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  • DOI: https://doi.org/10.1007/978-3-319-43341-7_65

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43339-4

  • Online ISBN: 978-3-319-43341-7

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