Gastroenterology Book

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Colonoscopy in GI BleedingAka: Lower Endoscopy Evaluation of GI Bleeding, Lower GI Endoscopic Evaluation of Bleeding

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  1. Indications
    1. Acute Gastrointestinal Bleeding
  2. Timing (Hospitalized patients)
    1. Colonoscopy within 24 hours
      1. Allows for adequate Bowel Preparation
      2. Allows for adequate Resuscitation
  3. Preparation
    1. Adequate Bowel Preparation is key to diagnosis
    2. Rapid Bowel Preparation in urgent Colonoscopy
      1. Administer 5 Liters of balanced electrolyte solution
      2. Administered over 2 to 7 hours
      3. Jensen (1988) Gastroenterology 95:1569
  4. Definitive Colonoscopic Diagnosis
    1. Pitfalls
      1. High false positive rate for wrong site of bleeding
      2. Sites commonly misdiagnosed as bleeding source
        1. Diverticula
        2. Angiodysplasia
    2. Criteria for definitive diagnosis of bleeding source
      1. Active bleeding
      2. Nonbleeding visible vessel
      3. Clot adherent to bleeding source
      4. Fresh blood in a short colonic segment
      5. Diverticular Ulceration with fresh blood nearby
  5. Management: Modalities for control of bleeding sites
    1. Thermal contact probe
    2. Nd-YAG Laser
    3. Epinephine injection
    4. Band ligation or metallic clip placement
  6. References
    1. (1998) Gastrointest Endosc 48:685
    2. Fallah (2000) Med Clin North Am 84(5):1183

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