#Acute Lower GI bleed, active, likely 2/2 to __________
Definition: Acute lower GI bleeding refers to acute blood loss originating the colon.
-DDx: LGI – Diverticulosis, angiodysplasia, AVM, neoplasm, IBD, infectious colitis, anorectal disease (hemorrhoids, fissures).
-A rectal exam performed. Guaiac stool.
-Admit to telemetry
-D/C and avoid all meds that can cause or worsen GI bleed (Anticoagulants, antiplatelets, NSAIDs)
-Initial Labs: CBC (H/H, platelets); Coag Studies(PT, INR); CMP (AST, ALT, Albumin, BUN, and Cr).
-CBC q6hrs to follow H/H in this active bleeder
–Type and screen (or *type and crossmatch for hemodynamic instability, severe bleeding, or high-risk pt)
-Closely monitor ABCs, clinical status, vital signs, cardiac rhythm, UOP, NG output (if NGT in place)
-Orthostatic vital signs stat and then q4hrs. Tachycardia and orthostatic HoTN suggest moderate blood loss; HoTN suggests life-threatening blood loss (HoTN may be late finding in healthy younger adults)
-Establish two large bore IV lines (16 gauge or larger)
-Give IVF bolus before giving PRBC. Also maintenance fluids.
-NPO
-Supplement Oxygen to keep saturation >92%
-Consult GI stat.
–Colonoscopy by GI when stable (A colonoscopy is the initial exam of choice for the dx and tx of acute LGIB). GI to consider EGD.
-PPI: Protonix drip – Pantoprazole 80mg in NS 100ml. Alt: Esomeprazole 40 mg IV bolus twice daily OR Pantoprazole 40 mg IV bolus twice daily
-IF pt devs hypotension, tx hypotension initially with rapid, bolus infusions of isotonic crystalloid
-IF needed, transfuse PRBC when:
–Hemodynamically unstable despite crystalloid resuscitation, OR
*–Hgb <9 in high-risk patients (eg, elderly, coronary artery disease), OR
*–Hgb <7 in low-risk patients
-IF coagulopathy devs, give FFP
-IF plt <50,000 or plt dysfunction (eg, chronic ASA tx), give plts
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** Treatment of LGIB is very similar to treatment of upper GI bleed.
This uptodate.com article has a good algorithm for use.