Focused Assessment in Acute Lower GI Bleeding
See also Table73.2 Focused assessment in acute upper GI bleeding History Ask about prior episodes and pre-existing conditions such diverticulosis, colitis or recent colonoscopy. Take careful drug history for anti-inflammatory drugs antiplatelet drugs and anticoagulants. Explore preceding symptoms such as weight loss and change in bowel habit, which may suggest malignancy. Check for significant comorbidities such as cardiac disease or renal impairment. Examination Estimate the volume of blood loss from the physiological observations: | |
| Major bleed (>1500mL; >30% of blood volume) | Minor bleed (≤750mL; <15% of blood volume) |
Pulse ≥120/min Systolic BP <120 mmHg (note this is influenced by age and usual blood pressure) Cool or cold extremities Tachypnoea (respiratory rate >20/min) Abnormal mental state: agitation, confusion, reduced conscious level | Pulse <100/min Systolic BP ≥120 mmHg, with postural fall <20 from lying to sitting Normal perfusion of extremities Normal respiratory rate Normal mental state |
Examine for signs of chronic liver disease/cirrhosis. Look for cachexia or obvious weight loss that may indicate an underlying malignancy. Rectal examination is essential to assess the stool and for rectal masses. This should always be performed in a sensitive manner with an appropriate chaperone. Unless the patient requests their presence, friends and family with the patient should be asked to leave the room when you perform this examination. | |