Suggested Algorithm for Pts with Acute Lower GI Bleeding - Flowchart

Suggested Algorithm for Pts with Acute Lower GI Bleeding - Flowchart

Suggested Algorithm for Pts with Acute Lower GI Bleeding - Flowchart

«Flowchart»

Acute lower GI bleeding

Acute lower GI bleeding

Acute lower GI bleeding

No hemodynamic instability

No hemodynamic instability

No hemodynamic instability

Hemodynamic instability

Hemodynamic instability

Hemodynamic instability

Upper endoscopy^{^}

Upper endoscopy^{^}

Upper endoscopy^{^}

^{^} ^{^}

Flexible sigmoidoscopy (colonoscopy if iron-deficiency anemia, familial colon cancer, or copious bleeding)^*

Flexible sigmoidoscopy (colonoscopy if iron-deficiency anemia, familial colon cancer, or copious bleeding)^*

Flexible sigmoidoscopy (colonoscopy if iron-deficiency anemia, familial colon cancer, or copious bleeding)^*

^* ^*

Age <40 years

Age <40 years

Age <40 years

Age 40 years

Age 40 years

Age >=40 years

End

End

End

Angiography

Angiography

Angiography

Obscure bleeding workup

Obscure bleeding workup

Obscure bleeding workup

Bleeding persists

Bleeding persists

Bleeding persists

Surgery

Surgery

Surgery

^* Some suggest colonoscopy for any degree of rectal bleeding in pts <40 years as well.

^* Some suggest colonoscopy for any degree of rectal bleeding in pts <40 years as well.

^* Some suggest colonoscopy for any degree of rectal bleeding in pts <40 years as well.

^*

^{^} If upper GI endoscopy reveals definite source, no further evaluation is needed.

^{^} If upper GI endoscopy reveals definite source, no further evaluation is needed.

^{^} If upper GI endoscopy reveals definite source, no further evaluation is needed.

^{^}

^† If massive bleeding does not allow time for colonic lavage, proceed to angiography.

^† If massive bleeding does not allow time for colonic lavage, proceed to angiography.

^† If massive bleeding does not allow time for colonic lavage, proceed to angiography.

^†

Colonoscopy^†

Colonoscopy^†

Colonoscopy^†

^† ^†

Colonoscopy

Colonoscopy

Colonoscopy

Site identified; bleeding stops

Site identified; bleeding stops

Site identified; bleeding stops

Site identified; bleeding persists

Site identified; bleeding persists

Site identified; bleeding persists

Site not identified; bleeding persists

Site not identified; bleeding persists

Site not identified; bleeding persists