Information ⬇
- History and physical examination (See below and Fig. 41-2).
- In the presence of hemodynamic changes, perform upper endoscopy followed by colonoscopy. In the absence of hemodynamic changes, perform anoscopy and either flexible sigmoidoscopy or colonoscopy: Exclude hemorrhoids, fissure, ulcer, proctitis, neoplasm.
- Colonoscopy: Often test of choice, but may be impossible if bleeding is massive.
- Barium enema: No role in active bleeding.
- Arteriography: When bleeding is severe (requires bleeding rate >0.5 mL/min; may require prestudy radioisotope bleeding scan as above); defines site of bleeding or abnormal vasculature.
- Surgical exploration (last resort).
Outline ⬆