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»

Start

Start

Start

End

End

End

No Hemodynamic Instability

No Hemodynamic Instability

No Hemodynamic Instability No Hemodynamic Instability

Hemodynamic Instability

Hemodynamic Instability

Hemodynamic Instability Hemodynamic Instability

Upper endoscopy

Upper endoscopy

Upper endoscopy

Colonoscopy

Colonoscopy

Colonoscopy

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

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

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

^a

Angiography

Angiography

Angiography

Workup for small intestinal/obscure bleeding site

Workup for small intestinal/obscure bleeding site

Workup for small intestinal/obscure bleeding site

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

Site not identified

Site not identified

Bleeding persists

Bleeding persists

Bleeding persists

Surgery

Surgery

Surgery

Age <40 years

Age <40 years

Age <40 years

Age 40 years

Age 40 years

Age >=40 years

Flexible sigmoidoscopy if minimal bleeding^a

Flexible sigmoidoscopy if minimal bleeding^a

^a ^a Flexible sigmoidoscopy if minimal bleeding[a]

Colonoscopy if more copious bleeding, family history of colon cancer, iron deficiency

Colonoscopy if more copious bleeding, family history of colon cancer, iron deficiency

Colonoscopy if more copious bleeding

Angiography (may perform CT angiography first)

Angiography (may perform CT angiography first)

Angiography (may perform CT angiography first)

No upper GI source

No upper GI source

No upper GI source

Able to prep

Able to prep

Able to prep

Too unstable to prep

Too unstable to prep

Too unstable to prep

Surgery (with intraoperative endoscopy if site has not been identified)

Surgery (with intraoperative endoscopy if site has not been identified)

Surgery (with intraoperative endoscopy if site has not been identified)

Bleeding persists

Bleeding persists

Bleeding persists

Able to prep

Able to prep

Able to prep

Instability persists

Instability persists

Instability persists