Surgery

60 year old man with lower GI bleeding

Grace Huang on May 26, 2013

Patient is a 60 year old Jehovah’s witness man who presents with lower GI bleeding.

 

What is the first step in approaching patient with lower GI bleeding?

Expand all answers
Assess ABC's
Correct. Patients may lose a considerable amount of blood through lower GI bleeds and can become hemodynamically unstable; therefore, it is important to assess ABC's in these patients.


Place NG tube
Although placing an NG tube can help distinguish between upper and lower GI causes of bleeding, first you want to assess the more urgent, potentially life threatening potential problems


CT scan
Abdominal X-Ray

  • Temp  37 C
  • HR  105
  • BP  100/80
  • RR  16
  • O2  99% on Room Air

2 large bore IV’s are established in his antecubital fossae and patient is started on crystalloid. NG tube returns bilious, non-bloody fluid. Patient reports 3 episodes of bright red blood per rectum (BRBPR) in the last 2 days with the last episode occurring 6 hours ago.  He has not had any normal episodes of bowel movement. This has not happened to him before. Associated symptoms also include dizziness upon standing up, nausea, and anorexia. He also confirms that because of his religious beliefs, he is unwilling to accept blood products, including albumin. He is started on iron and erythropoietin.

Which of the following physical exam findings are pertinent negatives in a patient presenting with lower GI bleed?

Select all that apply
Expand all answers
Absence of anal fissure
Correct. However, this would be unlikely in this patient as anal fissures are usually associated with pain and drops of blood in the toilet (and on the underwear) rather than maroon stools.


No masses palpated on rectal exam
Correct. A mass could represent an ulcerate colon cancer.


Well appearing in NAD
Correct. Lower GI bleed could lead to significant volume loss leading to confusion or lethargy.


Physical Exam

General: well appearing, NAD, dry mucus membranes
Abdominal: soft, nontender/nondistended
Rectal: no masses palpated, no blood on the glove

CBC
6
11
33
200

Patient is a 60 year old Jehovah’s witness man who presents with lower GI bleeding.

 

What is the first step in approaching patient with lower GI bleeding?

Expand all answers
Assess ABC's
Correct. Patients may lose a considerable amount of blood through lower GI bleeds and can become hemodynamically unstable; therefore, it is important to assess ABC's in these patients.


Place NG tube
Although placing an NG tube can help distinguish between upper and lower GI causes of bleeding, first you want to assess the more urgent, potentially life threatening potential problems


CT scan
Abdominal X-Ray

  • Temp  37 C
  • HR  105
  • BP  100/80
  • RR  16
  • O2  99% on Room Air

2 large bore IV’s are established in his antecubital fossae and patient is started on crystalloid. NG tube returns bilious, non-bloody fluid. Patient reports 3 episodes of bright red blood per rectum (BRBPR) in the last 2 days with the last episode occurring 6 hours ago.  He has not had any normal episodes of bowel movement. This has not happened to him before. Associated symptoms also include dizziness upon standing up, nausea, and anorexia. He also confirms that because of his religious beliefs, he is unwilling to accept blood products, including albumin. He is started on iron and erythropoietin.

Which of the following physical exam findings are pertinent negatives in a patient presenting with lower GI bleed?

Select all that apply
Expand all answers
Absence of anal fissure
Correct. However, this would be unlikely in this patient as anal fissures are usually associated with pain and drops of blood in the toilet (and on the underwear) rather than maroon stools.


No masses palpated on rectal exam
Correct. A mass could represent an ulcerate colon cancer.


Well appearing in NAD
Correct. Lower GI bleed could lead to significant volume loss leading to confusion or lethargy.


Physical Exam

General: well appearing, NAD, dry mucus membranes
Abdominal: soft, nontender/nondistended
Rectal: no masses palpated, no blood on the glove

CBC
6
11
33
200

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