Page 1480 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 105: Gastrointestinal Hemorrhage 1019

Suspected lower GI bleeding

• Resuscitation, multiple organ support
• Correct coagulopathy/thrombocytopenia
• Endotracheal intubation for shock
• Surgical consultation

Nasogastric tube aspiration

Positive aspirate or risk Negative aspirate and
factors for UGIB low risk for UGIB

Urgent colonoscopy
Urgent EGD Negative
after oral PEG purge
UGI source

Severe bleeding
Visualization Nonvisualization
Appropriate therapy A preventing endoscopic
of LGI source of LGI source
visualization

Angiography (± prior TRBC
Thermal/injection Bleeding
therapy scan) with possible diverticulum
angiographic therapy

Controlled bleeding:
- Small bowel studies in the Uncontrolled bleeding:
setting of unidentifiable Surgical therapy
colonic source

FIGURE 105-5. Management of lower GI hemorrhage. PEG, polyethylene glycol; TRBC, tagged RBC.

B
A

Bleeding
diverticulum

Hemostasis at
bleeding site

FIGURE 105-6. A. Bleeding colonic diverticulum prior to therapy. B. Successful hemostasis after thermal and injection therapy.
B

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Hemostasis at
bleeding site