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